Medicaid Managed Care Program Summary · Colorado Health Partnerships : Mental Health PIHP :...

Medicaid Managed Care Program Summary July 1, 2010

State Plan Managed

Care Entity Reimbursement

Arrangement Operating Authority Geographic Area Served

Number of Enrollees

AL Maternity Care Program Medical-only PAHP

Risk-based Capitation

1915(b) Statewide 21,969

AL Patient 1st PCCM Fee-For-Service 1915(b) Statewide 498,406

AR Connect Care PCCM Fee-For-Service 1115 Statewide 418,425

AR Non-Emergency Transportation Transp PAHP Risk-based Capitation


AR Total Life Healthcare PACE Risk-based Capitation

PACE 72315, 72319, 72324, 72354, 72365, 72373, 72387, 72396, 72401, 72404, 72411, 72414, 72416, 72417, 72419, 72421, 72427, 72432, 72433, 72437, 72438, 72442, 72447, 72450, 72455, 72465, 72467, 72472, 72476

36

AZ AZ Physicians IPA (Family Planning Extension)

Medicaid MCO Risk-based Capitation

1115 La Paz, Maricopa, Pima, Yuma 636

AZ AZ Physicians IPA (HP) Medicaid MCO Risk-based Capitation

1115 LaPaz, Maricopa, Pima, Yuma 246,797

AZ Bridgeway (Family Planning Extension) Medicaid MCO Risk-based Capitation

1115 Yavapai 69

AZ Bridgeway Health Solution (HP) Medicaid MCO Risk-based Capitation

1115 Yavapai 17,584

AZ Bridgeway Health Solution (PC) Medicaid MCO Risk-based Capitation

1115 La Paz, Maricopa, Yuma 2,761

AZ Care 1st Health Plan Medicaid MCO Risk-based Capitation

1115 Maricopa 51,030

AZ Care 1st Health Plan (Family Planning Extension)


1115 Maricopa 201

AZ Cochise Co. Dept. of Health Services (PC) Medicaid MCO Risk-based Capitation

1115 Cochise, Graham, Greenlee 899

AZ Department of Economic Security/Childrens Medical and Dental Program (Family Planning Extension)


1115 Statewide 0

AZ Department of Economic Security/Childrens Medical and Dental Program (HP)


1115 Statewide 9,448

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010

* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE

Page 23


State Plan Managed



Number of Enrollees

AZ Department of Economic Security/Division of Developmental Disabilities (PC)



AZ Department of Health Services (Behavioral Health)

MH/SUD PIHP Risk-based Capitation

1115 Apache, Cochise, Coconino, Gila, Graham, Greenlee, LaPaz, Maricopa, Mohave, Navajo, Pima, Pinal, Santa Cruz, Yavapai, Yuma

116,014

AZ Evercare Select (PC) Medicaid MCO Risk-based Capitation

1115 Apache, Coconino, Maricopa, Mohave, Navajo 3,178

AZ Health Choice Arizona (Family Planning Extension)


1115 Apache, Coconino, LaPaz, Maricopa, Mohave, Navajo, Pima, Santa Cruz, Yuma

678

AZ Health Choice Arizona (HP) Medicaid MCO Risk-based Capitation

1115 Apache, Coconino, LaPaz, Maricopa, Mohave, Navajo, Pima, Santa Cruz, Yuma

194,505

AZ Maricopa County Health Plan (Family Planning Extension)


1115 Maricopa 108

AZ Maricopa County Health Plan (HP) Medicaid MCO Risk-based Capitation

1115 Maricopa 53,757

AZ Mercy Care Plan (Family Planning Extension)


1115 Cochise, Graham, Greenlee, Maricopa, Pima 745

AZ Mercy Care Plan (HP) Medicaid MCO Risk-based Capitation

1115 Cochise, Graham, Greenlee, Maricopa, Pima 306,039

AZ Mercy Care Plan (PC) Medicaid MCO Risk-based Capitation

1115 Maricopa 8,503

AZ Phoenix Health Plan (Family Planning Extension)


1115 Apache, Coconino, Gila, Maricopa, Mohave, Navajo, Pima, Pinal, Yavapai

685

AZ Phoenix Health Plan (HP) Medicaid MCO Risk-based Capitation

1115 Apache, Coconino, Gila, Maricopa, Mohave, Navajo, Pima, Pinal, Yavapai

194,577

AZ Pima Health System (Family Planning Extension)


1115 Pima 1

AZ Pima Health System (HP) Medicaid MCO Risk-based Capitation

1115 Pima 1,865

AZ Pima Health System (PC) Medicaid MCO Risk-based Capitation

1115 Pima, Santa Cruz 4,312



4


State Plan Managed



Number of Enrollees

AZ Pinal County Long Term Care (PC) Medicaid MCO Risk-based Capitation

1115 Gila, Pinal 1,476

AZ SCAN Medicaid MCO Risk-based Capitation

1115 Maricopa 3,090

AZ University Family Care (Family Planning Extension)


1115 Cochise, Gila, Graham, Greenlee, Pima, Pinal, Santa Cruz 212

AZ University Family Care (HP) Medicaid MCO Risk-based Capitation

1115 Cochise, Gila, Graham, Greenlee, Pima, Pinal, Santa Cruz 69,308

AZ Yavapai County Long Term Care (PC) Medicaid MCO Risk-based Capitation

1115 Yavapai 1,013

CA Access Dental Plan-LA Dental PAHP Risk-based Capitation

1915(a) Los Angeles 133,787

CA Access Dental Plan-Sacramento Dental PAHP Risk-based Capitation

1915(b), 1932(a) Sacramento 116,356

CA Alameda Alliance for Health Commercial MCO Risk-based Capitation

1915(b), 1932(a) Alameda 97,471

CA AltaMed Health Services Corporation PACE Risk-based Capitation

PACE LA 732

CA American Health Guard-Dental Plan-LA Dental PAHP Risk-based Capitation


CA Anthem Blue Cross Partnership Plan - Sacramento

Commercial MCO Risk-based Capitation

1915(b), 1932(a) Sacramento 91,058

CA Anthem Blue Cross Partnership Plan-TPMP


1915(b), 1932(a) Alameda, Contra Costa, Fresno, San Francisco, San Joaquin, Santa Calra, Stanislaus, Tulare

327,858

CA Caloptima-Orange HIO Risk-based Capitation

1915(b) Orange 358,909

CA Care 1st Health Plan/San Diego Commercial MCO Risk-based Capitation

1915(b), 1932(a) San Diego 13,012

CA Care 1st Health Plan-Dental-LA Dental PAHP Risk-based Capitation


CA Central California Alliance For Health HIO Risk-based Capitation

1915(b) Merced, Monterey, Santa Cruz 177,532



Page 25


State Plan Managed



Number of Enrollees

CA Coalition of Elders Independence dba Center for Elders Independence

PACE Risk-based Capitation

PACE Alameda 449

CA Community Dental Services/Sacramento Dental PAHP Risk-based Capitation

1915(b), 1932(a) Sacramento 11,953

CA Community Dental Services-LA Dental PAHP Risk-based Capitation


CA Community Eldercare of San Diego dba St. Paul's PACE


PACE San Diego 107

CA Community Health Group Partnership Plan-San Diego


1915(b), 1932(a) San Diego 97,160

CA Contra Costa Health Plan Commercial MCO Risk-based Capitation

1915(b), 1932(a) Contra Costa 59,028

CA Health Net Community Solutions, Inc. - Sacramento


1915(b), 1932(a) Sacramento 49,580

CA Health Net Community Solutions, Inc.San Diego


1915(b), 1932(a) San Diego 29,887

CA Health Net Community Solutions, Inc.TPMP


1915(b), 1932(a) Fresno, Kern, LA, Stanislaus, Tulare 633,079

CA Health Net of CA-Dental-LA Dental PAHP Risk-based Capitation


CA Health Net of CA-Dental-Sacramento Dental PAHP Risk-based Capitation

1915(a) Sacramento 22,189

CA Health Plan of San Joaquin Commercial MCO Risk-based Capitation

1915(b), 1932(a) San Joaquin 74,969

CA Health Plan of San Mateo *MCO/COHS Risk-based Capitation

1915(b) San Mateo 57,753

CA Inland Empire Health Plan Commercial MCO Risk-based Capitation

1915(b), 1932(a) Riverside, San Bernardino 389,660

CA Kern Family Health Care Commercial MCO Risk-based Capitation

1915(b), 1932(a) Kern 104,658

CA KP Cal, LLC Commercial MCO Risk-based Capitation

1915(a) Marin, Sonoma 889



Page 26


State Plan Managed



Number of Enrollees

CA KP Cal, LLC - Sacramento Commercial MCO Risk-based Capitation

1915(b), 1932(a) Sacramento 26,528

CA KP Cal, LLC-San Diego Commercial MCO Risk-based Capitation

1915(b), 1932(a) San Diego 13,412

CA LA Care Health Plan Commercial MCO Risk-based Capitation

1915(b), 1932(a) Los Angeles 825,327

CA Liberty Dental Plan of CA/Sacramento Dental PAHP Risk-based Capitation

1915(b), 1932(a) Sacramento 27,661

CA Liberty Dental Plan of CA-LA Dental PAHP Risk-based Capitation

1915(b), 1932(a) LA 7,578

CA Molina Healthcare of California Partner Plan, Inc. - Sacramento


1915(b), 1932(a) Sacramento 26,956

CA Molina Healthcare of California Partner Plan, Inc. - San Diego


1915(b), 1932(a) San Diego 61,194

CA Molina Healthcare of California Partner Plan, Inc.-TPMP


1915(b), 1932(a) Riverside, San Bernardino 95,190

CA On Lok Senior Health Services dba On Lok Lifeways


PACE San Francisco 967

CA Partnership Health Plan HIO Risk-based Capitation

1915(b) Napa, Solano, Sonoma, Yolo 152,838

CA Positive Healthcare/AHF Healthcare Centers


1915(a) Los Angeles 761

CA Safeguard Dental-LA Dental PAHP Risk-based Capitation

1915(a) Los Angeles, Riverside, San Bernardino 20,656

CA San Francisco City & CO/Family Mosaic *Emotional and Mental Health Support PIHP


1915(a) San Francisco 106

CA San Francisco Health Plan Commercial MCO Risk-based Capitation

1915(b), 1932(a) San Francisco 38,241

CA Santa Barbara San luis Obispo Regional Health Authority

HIO Risk-based Capitation

1915(b) Santa Barbara 90,740

CA Santa Clara Family Health Plan Commercial MCO Risk-based Capitation

1915(b), 1932(a) Santa Clara 99,002

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 27 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE


State Plan Managed



Number of Enrollees

CA Senior Care Action Network (SCAN) Medicaid MCO Risk-based Capitation

1915(a) LA, Riverside, San Barnardino 7,440

CA Sutter Health sacramento Sierra dba Sutter Senior Care


PACE Sacramento, Yolo 211

CA Western Dental Services-LA Dental PAHP Risk-based Capitation

1915(a) Los Angeles, Riverside, Sacramento, San Bernardino 55,247

CA Western Dental Services-Sacramento Dental PAHP Risk-based Capitation

1915(b), 1932(a) Sacramento 88,030

CO Access Behavioral Care Mental Health PIHP


1915(b) Denver 91,556

CO Behavioral Healthcare, Inc. Mental Health PIHP


1915(b) East Metro Denver 124,334

CO Colorado Access Medicaid MCO Risk-based Capitation

1915(a) Adams, Arapahoe, Boulder, Broomfield, Denver 1,945

CO Colorado Health Partnerships Mental Health PIHP


1915(b) Alamosa, Archuleta, Baca, Bent, Chaffee, Conejos, Costilla, Crowley, Custer, Delta, Dolores, Eagle, El Paso, Fremont, Garfield, Grand, Gunnison, Hinsdale, Huerfano, Jackson, Kiowa, La Plata, Lake, Las Animas, Mesa, Mineral, Moffat, Montezuma, Montrose, Otero, Ouray, Park, Pitkin, Prowers, Pueblo, Rio Blanco, Rio Grande, Routt, Saguache, San Juan, San Miguel, Summit, Teller

180,658

CO Denver Health and Hospital Authority Medicaid MCO Risk-based Capitation

1915(a) Adams, Arapahoe, Denver, Jefferson 41,841

CO ePCCM *Enhanced PCCM

Fee-For-Service 1932(a) Statewide 2,746

CO Foothills Behavioral Health Partners Mental Health PIHP


1915(b), 1932(a)/1915(c)

Boulder, Broomfield, Clear Creek, Gilpin, Jefferson 59,560

CO Northeast Behavioral Health Partnership Mental Health PIHP


1915(b) Cheyenne, Elbert, Kit Carson, Larimer, Lincoln, Logan, Morgan, Phillips, Sedgwick, Washington, Weld, Yuma

66,437

CO Primary Care Physician Program PCCM Fee-For-Service 1932(a) Statewide 23,766

CO Rocky Mountain Health Plan Authority Medical-only PIHP

Non-risk Capitation

1915(a) Delta, Mesa, Montrose, Ouray, Rio Blanco, San Miguel 16,786

CO Rocky Mountain PACE PACE Risk-based Capitation

PACE El Paso 80



State Plan Managed



Number of Enrollees

CO Total Long Term Care PACE Risk-based Capitation

PACE Adams, Arapahoe, Denver, Jefferson 1,451

CO VOANS PACE, Inc PACE Risk-based Capitation

PACE Delta, Montrose 171

CT Aetna Better Health Commercial MCO Risk-based Capitation


CT Americhoice by United HealthCare Medicaid MCO Risk-based Capitation


CT Benecare *Dental ASO Fee-For-Service 1915(b) Statewide 542,524

CT Community Health Network of Connecticut Medicaid MCO Risk-based Capitation


CT HUSKY Primary Care PCCM Fee-For-Service 1915(b) Greater Hartford, Greater New Haven, Greater Waterbury, Greater Windham

425

CT Value Options *Mental Health ASO

Fee-For-Service 1915(b) Statewide 379,171

DC DC Chartered Health Plan, Incorporated Medicaid MCO Risk-based Capitation

1932(a) Statewide 104,240

DC Health Services For Children with Special Needs

Medical-only PIHP



DC Medical Transportation Management Transp PAHP Non-risk Capitation

1902(a)(70) Statewide 44,480

DC Unison Health Plan of the Capital Area Medicaid MCO Risk-based Capitation


DE Delaware Physicians Care, Inc Medicaid MCO Risk-based Capitation


DE Diamond State Partners *Fee for Service Model

Fee-For-Service 1115 Statewide 7,847

DE Unison Health Plan of Delaware, Inc. Medicaid MCO Risk-based Capitation


FL Access Health Solutions Medical-only PAHP

Non-risk Capitation

1915(b) Baker, Brevard, Broward, Clay, Duval, Flagler, Hardee, Indian River, Manatee, Martin, Nassau, Okeechobee, Orange, Osceola, Palm Beach, Polk, Seminole, St. Johns, St. Lucie, Volusia

43,343



Page 29


State Plan Managed



Number of Enrollees

FL AHF MCO of Florida, Inc.(Reform) Commercial MCO Risk-based Capitation

1115 County 33

FL AIDS Healthcare Foundation, Inc. Disease Management

PAHP

Non-risk Capitation


FL Alternative Medicine Integration Disease Management

PAHP

Non-risk Capitation

1915(b) Hillsborough, Pasco, Pinellas 476

FL American Eldercare Long Term Care PIHP


1915(a)/(c) Alachua, Brevard, Broward, Charlotte, Citrus, Clay, Dade, Duval, Escambia, Flagler, Hernando, Highlands, Hillsborough, Indian River, Lake, Lee, Manatee, Marion, Martin, Nassau, Okaloosa, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Santa Rosa, Sarasota, Seminole, St. Johns, St. Lucie, Sumter, Volusia, Walton

4,516

FL Amerigroup (NHD) Long Term Care PIHP


1915(a)/(c) Brevard, Broward, Charlotte, Citrus, Collier, Dade, Duval, Hernando, Hillsborough, Indian River, Lake, Lee, Manatee, Marion, Martin, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Johns, St. Lucie, Volusia

2,876

FL Amerigroup of Florida, Inc. Commercial MCO Risk-based Capitation

1915(b) Brevard, Broward, Dade, Hernando, Hillsborough, Lake, Lee, Manatee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, Volusia

166,201

FL Atlantic Dental, Inc. Dental PAHP Risk-based Capitation

1915(b) Dade 184,981

FL Better Health, LLC (Reform) Medical-only PIHP

FFS w/Some Risk Capitation

1115 Broward County 32,821

FL Caremark Disease Management

PAHP

Non-risk Capitation

1915(b) Statewide 88

FL Children's Medical Services (Reform) Medical-only PIHP

FFS/Some Risk Capitation

1115 Broward, Duval 6,647

FL Citrus (NHD) Long Term Care PIHP


1915(a)/(c) Alachua, Brevard, Broward, Citrus, Dade, Duval, Hernando, Hillsborough, Lake, Manatee, Marion, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, Volusia

1,969

FL Citrus Health Care, Inc. Commercial MCO Risk-based Capitation

1915(b) Hillsborough, Lake, Orange, Osceola, Pasco, Pinellas, Polk, Seminole

50,091



State Plan Managed



Number of Enrollees

FL Community Based Care Partnership, Ltd. Mental Health PIHP



FL Coventry Health Care of Florida, Inc. d/b/a Buena Vista


1915(b) Broward, Dade, Gadsden, Hendry, Jefferson, Leon, Liberty, Madison, Palm Beach, Wakulla

22,289

FL Coventry Health Care of Florida, Inc. d/b/a Vista


1915(b) Broward, Dade 20,367

FL First Coast Advantage (Reform) Medical-only PIHP


1115 Duval 45,806

FL Florida Health Partners, Inc. Mental Health PIHP


1915(b) Alachua, Bay, Bradford, Brevard, Calhoun, Charlotte, Citrus, Collier, Columbia, Dade, Desoto, Dixie, Escambia, Flagler, Franklin, Gadsden, Gilchrist, Glades, Gulf, Hamilton, Hardee, Hendry, Hernando, Highlands, Hillsborough, Holmes, Indian River, Jackson, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Martin, Monroe, Okaloosa, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Santa Rosa, Sarasota, Seminole, St Johns, St Lucie, Sumter, Suwannee, Taylor, Union, Volusia, Wakulla, Walton, Washington

241,809

FL Florida PACE Centers PACE Risk-based Capitation

PACE 33010, 33012, 33013, 33014, 33054, 33122, 33125, 33126, 33127, 33128, 33129, 33130, 33131, 33132, 33133, 33134, 33135, 33136, 33137, 33138, 33139, 33140, 33141, 33142, 33143, 33144, 33145, 33146, 33147, 33150, 33154, 33155, 33161, 33165, 33166, 33167, 33168, 33172, 33173, 33174, 33175, 33181, 33182, 33183, 33184

189

FL Freedom Health Plan, Inc. Commercial MCO Risk-based Capitation

1915(b) Dade, Hernando, Hillsborough, Manatee, Marion, Palm Beach, Pasco, Polk

2,471

FL Freedom Health Plan, Inc. (Reform) Commercial MCO Risk-based Capitation

1115 Broward 10,092

FL HealthEase of Florida, Inc. Medicaid MCO Risk-based Capitation

1915(b) Brevard, Broward, Calhoun, Citrus, Dade, Duval, Escambia, Gadsden, Highlands, Hillsborough, Jefferson, Lake, Leon, Liberty, Madison, Manatee, Marion, Martin, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Santa Rosa, Sarasota, Seminole, Volusia, Wakulla

157,552

FL HealthierFlorida (Pfizer Health Solutions, Inc.)

Disease Management

PAHP

Non-risk Capitation




State Plan Managed



Number of Enrollees

FL Hemophilia of the Sunshine State (Lynnfield Drug, Inc.)

Disease Management

PAHP

Non-risk Capitation

1915(b) Statewide 155

FL Hope Select Care PACE Risk-based Capitation

PACE Charlotte, Lee 111

FL Humana Medical Plan Long Term Care PIHP


1915(a)/(c) Broward, Dade, Duval, Flagler, Hillsborough, Manatee, Nassau, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Johns, Volusia

908

FL Humana Medical Plan, Inc. Commercial MCO Risk-based Capitation

1915(b) Broward, Dade, Palm Beach 42,390

FL Humana Medical Plan, Inc. (Reform) Commercial MCO Risk-based Capitation

1115 Broward 7,818

FL Humana Senior's Choice Long Term Care PIHP


1915(a)/(c) Brevard, Broward, Indian River, Martin, Okeechobee, Palm Beach, St. Lucie

412

FL Integral Health Plan Medicaid MCO Risk-based Capitation

1915(b) Collier, Manatee, Polk 9,558

FL Lakeview Center, Inc. Mental Health PIHP


1915(b) Escambia, Okaloosa, Santa Rosa, Walton 50,616

FL Life Hope Care Long Term Care PIHP


1915(a)/(c) Charlotte, Collier, Hendry, Lee 2

FL Little Havana Activities and Nutrition Centers

Long Term Care PIHP


1915(a)/(c) Broward, Dade, Palm Beach 1,195

FL Magellan Behavioral Health of Florida Mental Health PIHP


1915(b) Alachua, Bay, Bradford, Brevard, Calhoun, Charlotte, Citrus, Collier, Columbia, Dade, Desoto, Dixie, Escambia, Flagler, Franklin, Gadsden, Gilchrist, Glades, Gulf, Hamilton, Hardee, Hendry, Hernando, Highlands, Hillsborough, Holmes, Indian River, Jackson, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Martin, Monroe, Okaloosa, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Santa Rosa, Sarasota, Seminole, St Johns, St Lucie, Sumter, Suwannee, Taylor, Union, Volusia, Wakulla, Walton, Washington

244,408

FL Managed Care of North America Dental PAHP Risk-based Capitation

1915(b) Dade 52,522

FL Medica Health Plans of Florida, Inc. Commercial MCO Risk-based Capitation

1915(b) Dade 1,726



State Plan Managed



Number of Enrollees

FL Medica Health Plans of Florida, Inc. (Reform)


1115 Broward 1,663

FL MediPass PCCM Fee-For-Service 1915(b) Statewide 581,485

FL Molina Healthcare of Florida, Inc. Commercial MCO Risk-based Capitation

1915(b) Dade, Hillsborough, Palm Beach, Pasco, Pinellas, Polk 33,847

FL Molina Healthcare of Florida, Inc. (Reform) Commercial MCO Risk-based Capitation

1115 Broward 20,359

FL Neighborly Care Network Long Term Care PIHP


1915(a)/(c) Brevard, Broward, Citrus, Dade, Hernando, Hillsborough, Indian River, Manatee, Martin, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Lucie

730

FL Neighborly PACE PACE Risk-based Capitation

PACE Pinellas 60

FL North Florida Behavioral Health Partnership

Mental Health PIHP


1915(b) Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, Union

100,328

FL Personal Health Plan Medicaid MCO Risk-based Capitation

1915(b) Palm Beach 11,046

FL Preferred Medical Plan, Inc. Commercial MCO Risk-based Capitation

1915(b) Broward, Dade 16,062

FL Prestige Health Choice Medicaid MCO Risk-based Capitation

1915(b) Dade, Hillsborough, Lee, Orange, Pasco, Pinellas, Seminole 43,780

FL Project Independence at Home Long Term Care PIHP


1915(a)/(c) Dade 507

FL Public Health Trust of Dade County Mental Health PIHP


1915(b) Dade 69,075

FL Public Health Trust of Miami-Dade County Commercial MCO Risk-based Capitation

1915(b) Dade 15,124

FL Simply Healthcare Plans, Inc. Commercial MCO Risk-based Capitation

1915(b) Dade, Hillsborough, Osceola, Pinellas, Polk, Seminole 2,950

FL South Florida Community Care Network *Shared Savings Model


1915(b) Dade 8,713

FL South Florida Community Care Network (Reform)

Medical-only PIHP


1115 Broward 30,246



State Plan Managed



Number of Enrollees

FL Sunrise Community, Inc. *Adult Day Health Care

Fee-For-Service 1915(b)/(c) Lee, Palm Beach 36

FL Sunrise Home Health Long Term Care PIHP


1915(a)/(c) Dade 71

FL Sunshine State Health Plan Medicaid MCO Risk-based Capitation

1915(b) Dade, Hillbourough, Pasco, Pinellas, Polk 24,015

FL Sunshine State Health Plan (Reform) Medicaid MCO Risk-based Capitation

1115 Baker, Broward, Clay, Duval, Nassau 88,803

FL The Commission for the Transportation of the Disadvantaged

Transp PAHP Flat Rate per Ride 1915(b) Statewide 30,318

FL United Health Care (NHD) Long Term Care PIHP


1915(a)/(c) Brevard, Broward, Charlotte, Citrus, Dade, Duval, Hillsborough, Lake, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Johns, Volusia

1,167

FL United Healthcare of Florida, Inc. (Reform) Commercial MCO Risk-based Capitation

1115 Baker, Clay, Duval, Nassau 7,867

FL United Home Care Services Long Term Care PIHP


1915(a)/(c) Dade 35

FL UnitedHealthcare of Florida, Inc. Commercial MCO Risk-based Capitation

1915(b) Brevard, Broward, Citrus, Dade, Duval, Hernando, Highlands, Hillsborough, Lake, Manatee, Marion, Osceola, Palm Beach, Pasco, Pinellas, Polk, Seminole, Volusia

93,797

FL Universal Health Care (NHD) Long Term Care PIHP


1915(a)/(c) Brevard, Broward, Charlotte, Citrus, Clay, Collier, Dade, Hernando, Hillsborough, Lake, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Sarasota, Seminole

1,092

FL Universal Health Care, Inc. Commercial MCO Risk-based Capitation

1915(b) Dade, Gadsden, Hernando, Hillsborough, Jefferson, Leon, Manatee, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Wakulla

35,290

FL Universal Health Care, Inc. (Reform) Commercial MCO Risk-based Capitation

1115 Broward, Duval 16,521

FL Urban Jacksonville Long Term Care PIHP


1915(a)/(c) Clay, Duval, St. Johns 160

FL Vista Independence Plan Long Term Care PIHP


1915(a)/(c) Broward, Dade, Palm Beach 1,363



State Plan Managed



Number of Enrollees

FL WellCare of Florida, Inc. Commercial MCO Risk-based Capitation

1915(b) Brevard, Broward, Dade, Hernando, Hillsborough, Lee, Manatee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Lucie, Sumter

189,167

FL World Net, Inc. Long Term Care PIHP


1915(a)/(c) Escambia, Okaloosa, Santa Rosa, Walton 47

FL YourCare Brevard Long Term Care PIHP


1915(a)/(c) Brevard 144

GA Amerigroup Community Care Medicaid MCO Risk-based Capitation

1932(a) Atlanta Region, East Region, North Region, Southeast Region 221,242

GA Georgia Better Health Care PCCM Fee-For-Service 1932(a) Statewide 123,580

GA Non-Emergency Transportation Brokerage Transp PAHP Risk-based Capitation

1902(a)(70) Statewide 1,362,416

GA Peach State Health Plan Medicaid MCO Risk-based Capitation

1932(a) Atlanta Region, Central Region, Southwest Region 252,313

GA WellCare Medicaid MCO Risk-based Capitation

1932(a) Atlanta Region, Central Region, East Region, North Region, Southeast Region, Southwest Region

457,059

HI Aloha Care Medicaid MCO Risk-based Capitation


HI Evercare Commercial MCO Risk-based Capitation


HI HMSA-Medical Commercial MCO Risk-based Capitation

1115 Big Island, Kauai, Oahu 112,361

HI Kaiser Permanente Commercial MCO Risk-based Capitation

1115 Maui, Oahu 25,131

HI Maui PACE PACE Risk-based Capitation

PACE Maui 14

HI Ohana Commercial MCO Risk-based Capitation

1115 Maui 22,025

IA Iowa Plan For Behavioral Health MH/SUD PIHP Risk-based Capitation




State Plan Managed



Number of Enrollees

IA Medipass PCCM Fee-For-Service 1932(a) Adair, Adams, Allamakee, Appanoose, Audubon, Benton, Black Hawk, Boone, Bremer, Buchanan, Buena Vista, Butler, Calhoun, Carroll, Cass, Cedar, Cerro Gordo, Cherokee, Chickasaw, Clarke, Clay, Clayton, Clinton, Crawford, Dallas, Davis, Decatur, Delaware, Dickinson, Dubuque, Emmet, Fayette, Floyd, Franklin, Fremont, Greene, Grundy, Guthrie, Hamilton, Hancock, Hardin, Harrison, Henry, Howard, Humboldt, Ida, Jackson, Jasper, Jefferson, Johnson, Jones, Keokuk, Kossuth, Lee, Linn, Lucas, Lyon, Madison, Mahaska, Marion, Marshall, Mills, Mitchell, Monona, Monroe, Montgomery, Muscatine, O'Brien, Osceola, Page, Palo Alto, Plymouth, Pocahontas, Polk, Pottawattamie, Sac, Scott, Shelby, Sioux, Story, Tama, Taylor, Union, Van Buren, Warren, Wayne, Webster, Winnebago, Winneshiek, Woodbury, Worth, Wright

199,397

IA Siouxland PACE PACE Risk-based Capitation

PACE Cherokee, Ida, Monona, Plymouth, Sioux, Woodbury 71

ID Blue Cross of Idaho Dental PAHP Risk-based Capitation


ID Healthy Connections PCCM Fee-for-Service 1937 Statewide 186,988

ID Medicare-Medicaid Coordinated Plan Medical-only PAHP


1937 Ada, Bannock, Benewah, Boise, Bonner, Bonneville, Boundary, Canyon, Caribou, Cassia, Gem, Jefferson, Kootenai, Latah, Madison, Minidoka, Nez Perce, Oneida, Owyhee, Payette, Power, Shoshone, Twin Falls, Washington

956

IL Family Health Network Medicaid MCO Risk-based Capitation

1915(a) Cook 47,200

IL Harmony Health Plan Commercial MCO Risk-based Capitation

1915(a) Cook, Jackson, Kane, Madison, Perry, Randolph, St. Clair, Washington, Williamson

134,200

IL Illinois Health Connect PCCM Fee-For-Service 1932(a) Statewide 1,189,400

IL Meridian Health Plan Medicaid MCO Risk-based Capitation

1915(a) Adams, Brown, Cook, Henry, Mercer, Pike, Rock Island, Scott 800

IN Advantage Health Solutions-Care Select PCCM Fee-For-Service 1915(b) Statewide 32,974

IN Anthem-Healthy Indiana Plan Commercial MCO Risk-based Capitation


IN Anthem-Hoosier Healthwise Commercial MCO Risk-based Capitation

1115, 1915(b) Statewide 165,823



State Plan Managed



Number of Enrollees

IN Enhanced Services Plan (ESP)-Healthy Indiana Plan

*High Risk Plan Fee-For-Service 1115 Statewide 977

IN Managed Health Services (MHS)-Hoosier Healthwise


1115, 1915(b) Statewide 206,301

IN MDwise-Care Select PCCM Fee-For-Service 1915(b) Statewide 40,833

IN MDwise-Healthy Indiana Plan Commercial MCO Risk-based Capitation


IN MDwise-Hoosier Healthwise Commercial MCO Risk-based Capitation

1115, 1915(b) Statewide 282,526

KS Children's Mercy's Family Health Partners Medicaid MCO Risk-based Capitation

1932(a) Region 1 (NE/NCentral KS), Region 2 (SE/SCentral KS) 107,181

KS HealthConnect Kansas PCCM Fee-For-Service 1932(a) Statewide 23,065

KS Kansas Health Solutions Mental Health PAHP

Non-risk Capitation

1915(b)/(c) Statewide 258,423

KS Medical Transportation Management Inc. (MTM)

Transp PAHP Risk-based Capitation

1902(a)(70) Statewide 130,275

KS Midland Care Services PACE Risk-based Capitation

PACE Dogulas, Jackson, Jeffferson, Osage, Pottawatomie, Shawnee, Wabaunsee

79

KS UniCare Health Plan of Kansas, Inc. Medicaid MCO Risk-based Capitation


KS ValueOptions-Kansas Substance Use Disorders PIHP


1915(b)/(c) Statewide 258,423

KS Via Christi Healthcare Outreach Programs for Elders


PACE Sedgwick 200

KY Human Service Transportation Transp PAHP Risk-based Capitation

1902(a)(70) Statewide 716,854

KY Kentucky Patient Access and Care (KenPAC)

PCCM Fee-For-Service 1932(a) Statewide 315,085

KY Passport Health Plan Medicaid MCO Risk-based Capitation

1115 Jefferson County (Louisville) Kentucky and 15 surrounding counties

166,060

LA Community Care PCCM Fee-For-Service 1932(a) Statewide 752,027



Page 37


State Plan Managed



Number of Enrollees

LA Francican PACE Baton Rouge PACE Risk-based Capitation

PACE East Baton Rouge, West Baton Rouge 108

LA Greater New Orleans PACE Risk-based Capitation

PACE 70001, 70002, 70003, 70005, 70006, 70032, 70043, 70053, 70112, 70113, 70114, 70115, 70116, 70117, 70118, 70119, 70121, 70122, 70124, 70125, 70126, 70127, 70128, 70129, 70130, 70131

134

MA Boston Medical Center HealthNet Plan Medicaid MCO Risk-based Capitation

1115 Boston/Greater Boston Region, Central Region, Southern Region, Western Region

182,351

MA Commonwealth Care Alliance Medicaid MCO Risk-based Capitation

1915(a)/(c) Essex County, Hampden County, Middlesex County, Norfolk County, Plymouth County, Suffolk County

2,717

MA Elder Service Plan of Cambridge Health Alliance


PACE Allston, Cambridge, Somerville 222

MA Elder Service Plan of East Boston PACE Risk-based Capitation

PACE East Boston 298

MA Elder Service Plan of Harbor Health Services, Inc.


PACE Greater Boston 335

MA Elder Service Plan of the North Shore, Inc. PACE Risk-based Capitation

PACE Northeastern MA 736

MA Evercare SCO Medicaid MCO Risk-based Capitation

1915(a)/(c) Bristol County, Essex County, Hampden County (partial), Middlesex County, Norfolk County, Plymouth County (partial), Suffolk County, Worcester County (partial)

4,916

MA Fallon Community Health Plan Commercial MCO Risk-based Capitation

1115 Central Region 11,775

MA MA Behavioral Health Partnership MH/SUD PIHP Risk-based Capitation


MA NaviCare Medicaid MCO Risk-based Capitation

1915(a)/(c) Worcester County 516

MA Neighborhood Health Plan Commercial MCO Risk-based Capitation

1115 Boston/Greater Region, Central/Western Region, Northeast/Southeast Region

140,405

MA Network Health Medicaid MCO Risk-based Capitation

1115 Boston/Greater Boston Region, Central/Western Region, Northeast/Southeast Region

112,736

MA Primary Care Clinician Plan PCCM Fee-For-Service 1115 Statewide 322,823



Page 38


State Plan Managed



Number of Enrollees

MA Senior Whole Health Medicaid MCO Risk-based Capitation

1915(a)/(c) Bristol County, Essex County, Middlesex County, Norfolk County, Plymouth County, Suffolk County, Worcester County

6,527

MA Summit Elder Care PACE Risk-based Capitation

PACE Worchester 714

MA Uphams Elder Service Plan PACE Risk-based Capitation

PACE Boston 182

MD AMERIGROUP - PAC Medical-only PAHP


1115 Statewide except Allegany, Cecil, Garrett, St. Mar 3,608

MD AMERIGROUP Maryland Inc. Medicaid MCO Risk-based Capitation

1115 Statewide except Allegany, Cecil, Garrett, St. Mar 196,779

MD Hopkins Elder Plus PACE Risk-based Capitation

PACE 21052, 21202, 21205, 21206, 21213, 21214, 21217, 21218, 21219, 21220, 21221, 21222, 21224, 21227, 21231, 21237

147

MD JAI Medical System Medicaid MCO Risk-based Capitation

1115 Baltimore City, Baltimore County 13,106

MD JAI Medical Systems - PAC Medical-only PAHP


1115 Baltimore City, Baltimore County 6,485

MD Maryland Physicians Care Medicaid MCO Risk-based Capitation


MD Maryland Physicians Care - PAC Medical-only PAHP



MD Medstar Family Choice Medicaid MCO Risk-based Capitation

1115 Anne Arundel North, Baltimore City, Baltimore County, Western Harford County

27,068

MD Priority Partners - PAC Medical-only PAHP



MD Priority Partners MCO Medicaid MCO Risk-based Capitation


MD The Coordinating Center *Selective Contract

Fee-For-Service 1915(b)/(c) Statewide 687

MD The Diamond Plan Medicaid MCO Risk-based Capitation

1115 Baltimore City, Baltimore County, Harford 10,330

MD United Health Care Medicaid MCO Risk-based Capitation

1115 Statewide except Prince Georges County 127,019



Page 39


State Plan Managed



Number of Enrollees

MD United HealthCare - PAC Medical-only PAHP



ME MaineCare Primary Care Case Management

PCCM Fee-For-Service 1932(a) Statewide 194,464

MI Access Alliance of Michigan Mental Health PIHP


1915(b) Arenac, Bay, Huron, Montcalm, Shiawassee, Tuscola 57,789

MI BlueCaid of Michigan Medicaid MCO Risk-based Capitation

1915(b) Livingston, Washtenaw, Wayne 20,115

MI Care Resources PACE Capitation PACE Kent 201

MI CareSource of Michigan Medicaid MCO Risk-based Capitation

1915(b) Alcona, Allegan, Alpena, Antrim, Arenac, Benzie, Berrien, Calhoun, Cass, Charlevoix, Cheboygan, Crawford, Genesee, Gladwin, Grand Traverse, Ionia, Iosco, Kalamazoo, Kalkaska, Kent, Lake, Leelanau, Manistee, Mason, Mecosta, Missaukee, Montmorency, Newaygo, Oceana, Ogemaw, Osceola, Oscoda, Ottawa, Presque Isle, Roscommon, Saginaw, St. Joseph, Van Buren

37,272

MI CMH Affiliation of Mid-Michigan Mental Health PIHP


1915(b) Benzie, Clinton, Eaton, Gratiot, Ingham, Ionia, Manistee, Newago

90,563

MI CMH for Central Michigan Mental Health PIHP


1915(b) Clare, Gladwin, Isabella, Mecosta, Midland, Osceola 41,801

MI CMH Partnership of Southeast Michigan Mental Health PIHP


1915(b) Lenawee, Livingston, Monroe, Washtenaw 75,655

MI Comprehensive Senior Care Corporation PACE Risk-based Capitation

PACE Calhoun 78

MI Detroit-Wayne County CMH Agency Mental Health PIHP


1915(b) Wayne 431,254

MI Genesee County CMH Services Mental Health PIHP


1915(b) Genesee 90,490

MI Great Lakes Health Plan Medicaid MCO Risk-based Capitation

1915(b) Allegan, Berrien, Branch, Calhoun, Cass, Hillsdale, Huron, Jackson, Kalamazoo, Lenawee, Livingston, Macomb, Oakland, Saginaw, Sanilac, St. Clair, St. Joseph, Tuscola, Van Buren, Wayne

226,503



State Plan Managed



Number of Enrollees

MI Health Plan of Michigan Medicaid MCO Risk-based Capitation

1915(b) Allegan, Barry, Berrien, Branch, Calhoun, Cass, Clinton, Crawford, Eaton, Genesee, Hillsdale, Huron, Jackson, Kalamazoo, Kent, Lenawee, Livingston, Macomb, Manistee, Mason, Mecosta, Monroe, Montcalm, Muskegon, Newago, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Otsego,

MI HealthPlus Partners, Inc. Medicaid MCO Risk-based Capitation

1915(b)

Ottawa, Roscommon, Saginaw, Sanilac, Shiawassee, St. Clair, St. Joseph, Tuscola, Van Buren, Wayne

Bay, Genesee, Lapeer, Saginaw, Shiawassee, Tuscola

MI Healthy Kids Dental Dental PAHP Risk-based Capitation

1915(b) Alcona, Alger, Allegan, Alpena, Antrim, Arenac, Baraga, Barry, Benzie, Branch, Charlevoix, Cheboygan, Chippewa, Clare, Clinton, Crawford, Delta, Dickinson, Eaton, Emmet, Genesee, Gladwin, Gogebic, Gratiot, Hillsdale, Houghton, Huron, Ionia, Iosco, Iron, Isabella, Kalkaska, Keweenaw, Lake, Lapeer, Leelanau, Lenawee, Livingston, Luce, Mackinac, Manistee, Marquette, Menominee, Midland,

MI Henry Ford Health System-Center for Senior Independence


PACE

Missaukee, Monroe, Montmorency, Ogemaw, Ontonagon, Oscoda, Otsego, Presque Isle, Roscommon, Saginaw, Sanilac, Schoolcraft, Shiawassee, St. Clair, St. Joseph, Tuscola, Van Buren

48201, 48202, 48203, 48204, 48205, 48206, 48207, 48208, 48209, 48210, 48211, 48212, 48213, 48214, 48215, 48216, 48217, 48218, 48219, 48221, 48223, 48224, 48225, 48226, 48227, 48228, 48229, 48230, 48234, 48235, 48236, 48238,

MI Lakeshore Behavioral Health Alliance Mental Health PIHP


1915(b)

48239, 48240

Muskegon, Ottawa

MI Life Circles PACE Risk-based Capitation

PACE Muskegon, Ottawa

MI LifeWays Mental Health PIHP


1915(b) Hillsdale, Jackson

MI Macomb County CMH Services Mental Health PIHP


1915(b) Macomb

MI McLaren Health Plan Medicaid MCO Risk-based Capitation

1915(b) Arenac, Bay, Clinton, Crawford, Eaton, Genesee, Gratiot, Ingham, Ionia, Isabella, Lapeer, Macomb, Montcalm,

262,642

70,358

313,554

199

63,558

95

33,797

105,352

77,686

Oakland, Ogemaw, Oscoda, Roscommon, Saginaw, Shiawassee, Tuscola

MI Midwest Health Plan Medicaid MCO Risk-based Capitation

1915(b) Livingston, Macomb, Oakland, St. Clair, Washtenaw, Wayne 70,077



Page 41


State Plan Managed



Number of Enrollees

MI Molina Healthcare of Michigan Medicaid MCO Risk-based Capitation

1915(b) Alcona, Allegan, Arenac, Bay, Benzie, Clare, Crawford, Genesee, Gladwin, Gratiot, Huron, Ionia, Iosco, Isabella, Kent, Lake, Macomb, Manistee, Mason, Mecosta, Midland, Missaukee, Monroe, Montcalm, Montmorency, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Sanilac, St. Clair, Tuscola, Wayne, Wexford

217,673

MI Network 180 Mental Health PIHP


1915(b) Kent 95,087

MI Northcare Mental Health PIHP


1915(b) Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keeweenau, Luce, Mackinac, Marquette, Menominee, Ontonagon, Schoolcraft

44,169

MI Northern Affiliation Mental Health PIHP


1915(b) Alcona, Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Iosco, Kalkaska, Montmorency, Ogemaw, Oscoda, Otsego, Presque Isle

45,472

MI Northwest CMH Affiliation Mental Health PIHP


1915(b) Crawford, Grand Traverse, Lake, Leelanau, Mason, Missaukee, Oceana, Roscommon, Wexford

42,819

MI Oakland County CMH Authority Mental Health PIHP


1915(b) Oakland 114,353

MI Omnicare Health Plan Medicaid MCO Risk-based Capitation

1915(b) Oakland, Wayne 51,725

MI Physicians Health Plan of Mid-Michigan Family Care


1915(b) Ingham, Ionia, Montcalm, Shiawassee 18,305

MI Priority Health Government Programs, Inc. Medicaid MCO Risk-based Capitation

1915(b) Allegan, Kent, Lake, Manistee, Mecosta, Montcalm, Muskegon, Oceana, Osceola, Ottawa

61,188

MI ProCare Health Plan Medicaid MCO Risk-based Capitation

1915(b) Wayne 1,578

MI Saginaw County CMH Authority Mental Health PIHP


1915(b) Saginaw 40,597

MI Southwest Michigan Urban & Rural Consortium

Mental Health PIHP


1915(b) Allegan, Cass, Kalamazoo, St. Joseph 71,992

MI Thumb Alliance PIHP Mental Health PIHP


1915(b) Lapeer, Sanilac, St. Clair 45,816

MI Total Health Care Medicaid MCO Risk-based Capitation

1915(b) Genesee, Macomb, Oakland, Wayne 52,817



State Plan Managed



Number of Enrollees

MI Upper Peninsula Health Plan Medicaid MCO Risk-based Capitation

1915(b) Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keewenaw, Luce, Mackinac, Marquette, Menominee, Ontonagon, Schoolcraft

28,748

MI Venture Behavioral Health Mental Health PIHP


1915(b) Barry, Berrien, Branch, Calhoun, VanBuren 86,024

MN Blue Plus Commercial MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Aitkin, Anoka, Becker, Beltrami, Benton, Big Stone, Blue Earth, Brown, Carlton, Carver, Cass, Chippewa, Chisago, Clay, Clearwater, Cook, Cottonwood, Crow Wing, Dakota, Dodge, Douglas, Faribault, Fillmore, Freeborn, Goodhue, Grant, Hennepin, Houston, Hubbard, Isanti, Itasca, Jackson, Kanabec, Kandiyohi, Kittson, Koochiching, Lac Qui Parle, Lake, Lake of the Woods, LeSueur, Lincoln, Lyon, Mahnomen, Marshall, Martin, Mcleod, Meeker, Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Pipestone, Polk, Pope, Ramsey, Red Lake, Redwood, Renville, Rice, Rock, Rouseau, Scott, Sherburne, Sibley, St. Louis, Stearns, Steele, Stevens, Swift, Todd, Traverse, Wabasha, Wadena, Waseca, Washington, Watonwan, Wilkin, Winona, Wright, Yellow Medicine

111,508

MN Health Partners Commercial MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Anoka, Benton, Carver, Chisago, Dakota, Hennepin, McLeod, Meeker, Ramsey, Scott, Sherburne, Stearns, Washington, Wright

50,312

MN Itasca Medical Care Medicaid MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Itasca 5,169

MN Medica Commercial MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Aitkin, Anoka, Becker, Benton, Carlton, Carver, Cass, Chisago, Clay, Crow Wing, Dakota, Hennepin, Isanti, Koochiching, Lake, Mahnomen, Mille Lacs, Morrison, Norman, Otter Tail, Pine, Polk, Ramsey, Rice, Scott, Sherburne, St. Louis, Stearns, Todd, Wadena, Washington, Wilkin, Wright

133,141

MN Metropolitan Health Plan Commercial MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Anoka, Carver, Hennepin, Mower, Scott 15,925

MN PrimeWest Health System Medicaid MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Beltrami, Big Stone, Clearwater, Douglas, Grant, Hubbard, McLeod, Meeker, Pipestone, Pope, Renville, Stevens, Traverse

19,737



State Plan Managed



Number of Enrollees

MN South Country Health Alliance Medicaid MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Brown, Cass, Crow Wing, Dodge, Freeborn, Goodhue, Kanabec, Morrison, Sibley, Steele, Todd, Wabasha, Wadena, Waseca

30,376

MN UCARE Commercial MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Aitkin, Anoka, Benton, Big Stone, Blue Earth, Brown, Carlton, Carver, Cass, Chippewa, Chisago, Cook, Cottonwood, Crow Wing, Dakota, Dodge, Douglas, Faribault, Fillmore, Freeborn, Goodhue, Grant, Hennepin, Houston, Isanti, Jackson, Kanabec, Kandiyohi, Kittson, Koochiching, Lac Qui Parle, Lake, LeSueur, Lincoln, Lyon, Marshall, Martin, McLeod, Meeker, Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Pipestone, Polk, Pope, Ramsey, Red Lake, Redwood, Renville, Rice, Rock, Roseau, Scott, Sherburne, Sibley, St. Louis, Stearns, Steele, Stevens, Swift, Todd, Traverse, Wabasha, Wadena, Waseca, Washington, Watonwan, Winona, Wright, Yellow Medicine

102,269

MO Alexian Brothers Community Services PACE Risk-based Capitation

PACE St. Louis City, St. Louis County 180

MO Blue Advantage Plus of Kansas City Medicaid MCO Risk-based Capitation

1915(b) Cass, Clay, Henry, Jackson, Johnson, Lafayette, Platte, Ray, St. Clair

27,413

MO Childrens Mercy Family Health Partners Medicaid MCO Risk-based Capitation

1915(b) Bates, Cass, Cedar, Clay, Henry, Jackson, Johnson, Lafayette, Platte, Polk, Ray, St. Clair, Vernon

48,739

MO Harmony Health Plan of Missouri Medicaid MCO Risk-based Capitation

1915(b) Franklin, Jefferson, Lincoln, Madison, Perry, Pike, St. Charles, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Warren, Washington

14,571

MO HealthCare USA Medicaid MCO Risk-based Capitation

1915(b) Audrain, Bates, Benton, Boone, Callaway, Camden, Cass, Cedar, Chariton, Clay, Cole, Cooper, Franklin, Gasconade, Henry, Howard, Jackson, Jefferson, Johnson, Laclede, Lafayette, Lincoln, Linn, Macon, Madison, Maries, Marion, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Perry, Pettis, Phelps, Pike, Platte, Polk, Pulaski, Ralls, Randolph, Ray, Saline, Shelby, St. Charles, St. Clair, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Vernon, Warren, Washington

174,092

MO LogistiCare Solutions, LLC Transp PAHP Risk-based Capitation

1902(a)(70) Statewide 507,160



State Plan Managed



Number of Enrollees

MO Missouri Care Medicaid MCO Risk-based Capitation


42,352

MO Molina Healthcare of Missouri Medicaid MCO Risk-based Capitation


69,643

MS LogistiCare Solutions, LLC Transp PAHP Risk-based Capitation

1902(a)(70) Statewide 533,107

MT Billings Clinic PACE Risk-based Capitation

PACE 59002, 59006, 59015, 59024, 59037, 59044, 59047, 59064, 59079, 59088, 59101, 59102, 59105, 59106

43

MT Health Improvement Program *Enhanced Primary Care

Case Managment


MT Passport to Health PCCM Fee-For-Service 1915(b) Statewide 69,610

NC Carolina Access PCCM Fee-For-Service 1932(a) Statewide 74,379

NC Community Care of North Carolina (Access II/III)

PCCM Fee-For-Service 1932(a) Statewide 1,041,665

NC Elderhaus PACE Risk-based Capitation

PACE Brunswick, New Hanover 51

NC Piedmont Cardinal Health Plan MH/SUD PIHP Risk-based Capitation

1915(b)/(c) Rowan, Stanly, Davidson, Union and Cabarrus Counties 81,733

NC Piedmont SeniorCare PACE Risk-based Capitation

PACE Caswell, Yancy 63



State Plan Managed



Number of Enrollees

ND ExperienceHealth ND Disease Management

PAHP



ND Northland PACE PACE Risk-based Capitation

PACE 58501, 58502, 58503, 58504, 58554, 58558, 58601, 58602, 58652, 58655, 58656

51

ND Primary Care Case Management PCCM Fee-For-Service 1932(a) Statewide 41,987

NE Magellan Behavioral Health *Specialty Physician Case Management

(SPCM) Program


NE Primary Care Plus PCCM Fee-For-Service 1915(b), 1932(a) Douglas, Lancaster, Sarpy 50,544

NE Share Advantage Commercial MCO Risk-based Capitation

1915(b), 1932(a) Douglas, Lancaster, Sarpy 40,247

NJ AmeriChoice of New Jersey, Inc. Commercial MCO Risk-based Capitation

1915(b), 1932(a) Statewide 288,539

NJ AMERIGROUP New Jersey, Inc. Medicaid MCO Risk-based Capitation

1915(b), 1932(a) Atlantic, Bergen, Burlington, Camden, Cape May, Cumberland, Essex, Gloucester, Hudson, Hunterdon, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset, Sussex, Union, Warren

115,257

NJ Healthfirst Health Plan of New Jersey, Inc. Medicaid MCO Risk-based Capitation

1915(b), 1932(a) Bergen, Essex, Hudson, Mercer, Middlesex, Morris, Passaic, Somerset, Sussex, Union

15,519

NJ Horizon NJ Health Medicaid MCO Risk-based Capitation

1915(b), 1932(a) Statewide 378,983

NJ Life at Lourdes PACE Risk-based Capitation

PACE 08002, 08003, 08004, 08007, 08009, 08012, 08021, 08026, 08029, 08030, 08031, 08033, 08034, 08035, 08043, 08045, 08049, 08059, 08078, 08081, 08083, 08084, 08091, 08095, 08099, 08101, 08102, 08103, 08104, 08105, 08106, 08107, 08108, 08109, 08110, 08505, 08518, 08554, Mercer County

107

NJ Life St. Francis PACE Risk-based Capitation

PACE 08505, 08518, 08554 86

NJ LogistiCare Transp PAHP Risk-based Capitation

1902(a)(70) Statewide 798,299

NM AMERIGROUP Community Care of New Mexico, Inc.


1915(b)/(c) Statewide 19,422



State Plan Managed



Number of Enrollees

NM Blue Cross Blue Shield of New Mexico Commercial MCO Risk-based Capitation


NM Evercare of New Mexico Commercial MCO Risk-based Capitation

1915(b)/(c) Statewide 18,761

NM Lovelace Community Health Plan Commercial MCO Risk-based Capitation

1115, 1915(b) Statewide 90,459

NM Molina Healthcare of New Mexico Medicaid MCO Risk-based Capitation

1115, 1915(b) Statewide 85,144

NM OptumHealth New Mexico Mental Health PIHP



NM Presbyterian Health Plan Commercial MCO Risk-based Capitation

1115, 1915(b) Statewide 166,560

NM Total Community Care (PACE) PACE Risk-based Capitation

PACE Bernalillo County, Sandoval County, Valencia County 388

NV Amerigroup Community Care Medicaid MCO Risk-based Capitation


NV Health Plan of Nevada Commercial MCO Risk-based Capitation

1932(a) Clark, Washoe 78,256

NV Logisticare Transp PAHP Risk-based Capitation


NY Affinity Health Plan Medicaid MCO Risk-based Capitation

1115 Bronx, Kings, Nassau, New York, Orange, Queens, Richmond, Rockland, Suffolk, Westchester

236,209

NY Affinity/Medicaid Advantage Commercial MCO Risk-based Capitation

1115 Statewide 138

NY Amerigroup Medicaid MCO Risk-based Capitation

1115 New York City, Putnam 99,639

NY AmeriGroup Advantage Plus/Medicaid Advantage Plus

Long Term Care PIHP


1915(a) Statewide 18

NY Amerigroup Community Connections Long Term Care PIHP


1915(a) New York City 814

NY AmidaCare Special Needs Medicaid MCO Risk-based Capitation

1115 Bronx, Brooklyn, Manhattan, Queens, Staten Island 1,430



Page 47


State Plan Managed



Number of Enrollees

NY ArchCare Senior Life PACE Risk-based Capitation

PACE New York City 62

NY Capital District Physicians Health Plan Commercial MCO Risk-based Capitation

1115 Albany, Broome, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Tioga, Washington

61,807

NY Catholic Health - LIFE PACE Risk-based Capitation

PACE Erie 34

NY CCM Select Long Term Care PIHP



NY Comprehensive Care Management (CCM) PACE Risk-based Capitation

PACE New York City, Westchester 2,590

NY Eddy Senior Care PACE Risk-based Capitation

PACE Albany, Schenectady 114

NY Elder Plan/Medicaid Advantage Plus Long Term Care PIHP



NY Excellus Commercial MCO Risk-based Capitation

1115 Broome, Chemung, Clinton, Essex, Franklin, Herkimer, Livingston, Madison, Monroe, Oneida, Onondaga, Ontario, Orleans, Oswego, Otsego, Seneca, St Lawrence, Wayne, Yates

124,269

NY Fidelis Care at Home Long Term Care PIHP


1115 Orange, Rockland 345

NY GHI *PPO Risk-based Capitation


NY GHI/Medicaid Advantage Commercial MCO Risk-based Capitation

1115 Statewide 898

NY Guildnet Long Term Care PIHP


1915(a) New York City 6,432

NY GuildNet/Medicaid Advantage Plus Long Term Care PIHP



NY Health Advantage/Elant Choice Long Term Care PIHP


1915(a) Orange 151

NY Health First Medicaid MCO Risk-based Capitation

1115 Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk 429,385



State Plan Managed



Number of Enrollees

NY Health Now Commercial MCO Risk-based Capitation

1115 Albany, Allegany, Cattauragus, Chautauqua, Clinton, Columbia, Erie, Essex, Fulton, Genesee, Greene, Montgomery, Niagara, Orleans, Rensselaer, Saratoga, Schenectady, Warren, Washington, Wyoming

41,317

NY HealthPlus Medicaid MCO Risk-based Capitation

1115 Bronx, Kings, New York, Queens, Richmond 276,185

NY HHH Choices Long Term Care PIHP



NY HIP Combined Commercial MCO Risk-based Capitation

1115 Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk, Westchester

254,483

NY HIP Health Plan/Medicaid Advantage Commercial MCO Risk-based Capitation


NY HomeFirst Long Term Care PIHP



NY Hudson Health Plan Medicaid MCO Risk-based Capitation

1115 Dutchess, Orange, Rockland, Sullivan, Ulster, Westchester 79,575

NY Independent Care Systems Long Term Care PIHP



NY Independent Health/Hudson Valley&WNY Commercial MCO Risk-based Capitation

1115 Erie, Niagara 36,785

NY Independent Living For Seniors PACE Risk-based Capitation

PACE Monroe 279

NY Liberty Health Advantage/Medicaid Advantage


1115 Statewide 740

NY Managed Health Inc/Medicaid Advantage Commercial MCO Risk-based Capitation

1115 Statewide 59

NY MetroPlus Health Plan Medicaid MCO Risk-based Capitation

1115 Bronx, Kings, New York, Queens 368,502

NY MetroPlus Health Plan Special Needs Medicaid MCO Risk-based Capitation

1115 Bronx, Brooklyn, Manhattan, Queens 3,386

NY MetroPlus/Medicaid Advantage Commercial MCO Risk-based Capitation

1115 Statewide 48



Page 49


State Plan Managed



Number of Enrollees

NY MVP Health Plan Commercial MCO Risk-based Capitation

1115 Dutchess, Ulster 36,132

NY Neighborhood Health Providers Medicaid MCO Risk-based Capitation

1115 Bronx, Kings, New York, Queens, Richmond 196,532

NY NYPS Select Health Special Needs Medicaid MCO Risk-based Capitation


NY NYS Catholic Health Plan 1199 Commercial MCO Risk-based Capitation


NY NYS Catholic Health Plan/Fidelis Medicaid MCO Risk-based Capitation

1115 Albany, Bronx, Broome, Cattauragus, Chautauqua, Clinton, Columbia, Cortland, Dutchess, Erie, Essex, Greene, Hamilton, Herkimer, Kings, Nassau, New York, Niagara, Oneida, Onondaga, Orleans, Oswego, Queens, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Suffolk, Warren, Washington, Westchester

525,693

NY NYS Catholic Health Plan/Fidelis/Medicaid Advantage


1115 Statewide 486

NY NYS Catholic Health Plan/Fidelis/Medicaid Advantage Plus

Long Term Care PIHP



NY PACE CNY PACE Risk-based Capitation

PACE Onondaga 397

NY Physician Case Management Program PCCM Risk-based Capitation

1115 Erie 4,804

NY SCHC TotalCare Medicaid MCO Risk-based Capitation

1115 Onondaga, Oswego, Tompkins 37,305

NY Senior Health Partners Long Term Care PIHP



NY Senior Network Health Long Term Care PIHP



NY Senior Whole Health/ Medicaid Advantage Commercial MCO Risk-based Capitation

1115 Statewide 536

NY Senior Whole Health/Medicaid Advantage Plus

Long Term Care PIHP



NY Southern Tier Pediatrics PCCM Risk-based Capitation

1115 Chemung, Steuben 4,237



State Plan Managed



Number of Enrollees

NY Southern Tier Priority PCCM Risk-based Capitation

1115 Chemung, Schuyler, Steuben 6,479

NY Total Aging in Place Long Term Care PIHP


1915(a) Erie 149

NY Total Senior Care PACE Risk-based Capitation

PACE Cattaraugus 43

NY Touchstone/Prestige/Medicaid Advantage Commercial MCO Risk-based Capitation


NY United Healthcare Commercial MCO Risk-based Capitation

1115 Bronx, Kings, Nassau, Queens, Richmond, Suffolk 240,251

NY Univera Community Health Medicaid MCO Risk-based Capitation

1115 Allegany, Cattaraugus, Chautauqua, Erie 38,605

NY VNS Choice Long Term Care PIHP



NY VNS Choice Plus/Medicaid Advantage Plus

Long Term Care PIHP



NY Wellcare Commercial MCO Risk-based Capitation

1115 Albany, Bronx, Columbia, Dutchess, Greene, Kings, New York, Orange, Queens, Rensselaer, Rockland, Sullivan, Ulster

77,201

NY WellCare Advantage Plus/Medicaid Advantage Plus

Long Term Care PIHP



NY WellCare Advocate Long Term Care PIHP



OH Amerigroup Ohio Medicaid MCO Risk-based Capitation

1932(a) Southwest, West Central 57,883

OH Buckeye Community Health Plan Medicaid MCO Risk-based Capitation

1932(a) East Central, Northeast, Northwest, Southwest 158,381

OH CareSource Medicaid MCO Risk-based Capitation

1932(a) Central, East Central, Northeast, Northeast Central, Northwest, Southeast, Southwest, West Central

801,056

OH McGregor PACE PACE Risk-based Capitation

PACE Cuyahoga 192

OH Molina Healthcare of Ohio Medicaid MCO Risk-based Capitation

1932(a) Central, Southeast, Southwest, West Central 233,625



Page 51


State Plan Managed



Number of Enrollees

OH Paramount Advantage Medicaid MCO Risk-based Capitation

1932(a) Northwest 87,072

OH TriHealth Senior Link PACE Risk-based Capitation

PACE Butler, Clermont, Hamilton, Warren 540

OH Unison Health Plan of Ohio Medicaid MCO Risk-based Capitation

1932(a) East Central, Northeast Central, Northwest, Southeast 121,891

OH WellCare of Ohio Medicaid MCO Risk-based Capitation

1932(a) Northeast 101,033

OK Cherokee Elder Care PACE Risk-based Capitation

PACE 74347, 74352, 74364, 74368, 74401, 74423, 74427, 74434, 74441, 74451, 74452, 74464, 74471

57

OK SoonerCare American Indian PCCM PCCM Fee-For-Service 1115 Statewide 14,247

OK SoonerCare PCCM PCCM Fee-For-Service 1115 Statewide 434,969

OK SoonerRide Transp PAHP Risk-based Capitation

1902(a)(70) Statewide 603,083

OR Accountable Behavioral Health Mental Health PIHP


1115 Benton, Crook, Deschutes, Jefferson, Lincoln 34,237

OR Capitol Dental Care Inc. Dental PAHP Risk-based Capitation

1115 Benton, Clackamas, Clatsop, Columbia, Hood River, Jackson, Josephine, Klamath, Lane, Lincoln, Linn, Marion, Morrow, Multnomah, Polk, Umatilla, Union, Wasco, Washington, Yamhill

153,973

OR Care Oregon Medicaid MCO Risk-based Capitation

1115 Clackamas, Clatsop, Columbia, Coos, Douglas, Jackson, Klamath, Lincoln, Marion, Morrow, Multnomah, Polk, Tillamook, Umatilla, Washington, Yamhill

127,691

OR Cascade Comprehensive Care Medicaid MCO Risk-based Capitation

1115 Klamath 8,265

OR Central Oregon Independent Health Solutions


1115 Crook, Deschutes, Grant, Harney, Hood River, Jefferson, Klamath, Lake, Sherman, Wasco, Wheeler

15,454

OR Clackamas County Mental Health Mental Health PIHP


1115 Clackamas, Gilliam, Hood River, Marion, Sherman, Wasco 27,725

OR Doctors of the Oregon Coast South Medicaid MCO Risk-based Capitation

1115 Coos 9,663

OR Douglas County IPA Commercial MCO Risk-based Capitation

1115 Douglas 13,261



State Plan Managed



Number of Enrollees

OR FamilyCare (Mental Health) Mental Health PIHP


1115 Clackamas, Multnomah, Washington 26,314

OR FamilyCare Health Plans Commercial MCO Risk-based Capitation

1115 Clackamas, Jackson, Josephine, Morrow, Multnomah, Umatilla, Washington

38,018

OR Greater Oregon Behavioral Health, Inc. Mental Health PIHP


1115 Baker, Clatsop, Columbia, Grant, Harney, Lake, Malheur, Morrow, Umatilla, Union, Wallowa, Wheeler

50,693

OR Inter-Community Health Network Medicaid MCO Risk-based Capitation

1115 Benton, Lincoln, Linn, Tillamook 23,791

OR Jefferson Behavioral Health Mental Health PIHP


1115 Coos, Curry, Douglas, Jackson, Josephine, Klamath 61,720

OR Kaiser Permanente Oregon Plus Medicaid MCO Risk-based Capitation

1115 Clackamas, Marion, Multnomah, Polk 9,878

OR Lane Care MHO Mental Health PIHP


1115 Lane 42,122

OR Lane Individual Practice Association Medicaid MCO Risk-based Capitation

1115 Benton, Lane, Linn 35,800

OR Managed Dental Care of Oregon Dental PAHP Risk-based Capitation

1115 Benton, Clackamas, Clatsop, Columbia, Hood River, Jackson, Josephine, Linn, Marion, Multnomah, Polk, Tillamook, Washington, Yamhill

13,906

OR Marion Polk Community Health Plan Medicaid MCO Risk-based Capitation

1115 Benton, Clackamas, Linn, Marion, Polk, Yamhill 51,128

OR Mid Valley Behavioral Care Network Mental Health PIHP


1115 Linn, Marion, Polk, Tillamook, Yamhill 88,667

OR Mid-Rogue Independent Practice Assoc. Medicaid MCO Risk-based Capitation

1115 Douglas, Jackson, Josephine 16,961

OR Multicare Dental Dental PAHP Risk-based Capitation

1115 Clackamas, Multnomah, Washington 31,357

OR Multnomah County Verity Mental Health PIHP


1115 Multnomah 76,769



State Plan Managed



Number of Enrollees

OR Northwest Dental Services Dental PAHP Risk-based Capitation

1115 Baker, Benton, Clackamas, Clatsop, Columbia, Coos, Crook, Curry, Deschutes, Douglas, Gilliam, Grant, Harney, Hood River, Jackson, Jefferson, Josephine, Klamath, Lake, Lane, Lincoln, Linn, Malheur, Marion, Morrow, Multnomah, Polk, Sherman, Umatilla, Union, Wallowa, Wasco, Washington, Wheeler, Yamhill

140,037

OR ODS Community Health Inc. Medicaid MCO Risk-based Capitation

1115 Baker, Clatsop, Columbia, Deschutes, Jackson, Malheur, Union, Wallowa, Yamhill

8,970

OR Oregon Dental Service Dental PAHP Risk-based Capitation

1115 Baker, Benton, Clackamas, Clatsop, Columbia, Crook, Deschutes, Hood River, Jackson, Jefferson, Josephine, Lane, Linn, Malheur, Marion, Multnomah, Polk, Tillamook, Umatilla, Wasco, Washington, Yamhill

57,674

OR Oregon Health Management Service Medicaid MCO Risk-based Capitation

1115 Douglas, Jackson, Josephine 4,552

OR PCCM PCCM Fee-For-Service 1115 Statewide 4,044

OR Providence Elder Place PACE Risk-based Capitation

PACE 97009, 97010, 97014, 97019, 97024, 97030, 97034, 97035, 97056, 97060, 97080, 97124, 97133, 97201, 97202, 97203, 97204, 97205, 97206, 97209, 97210, 97211, 97212, 97213, 97215, 97216, 97217, 97218, 97219, 97220, 97221, 97222, 97225, 97227, 97229, 97230, 97231, 97232, 97233, 97236, 97239, 97258, 97266

842

OR Providence Health Assurance Medicaid MCO Risk-based Capitation

1115 Clackamas, Multnomah, Washington, Yamhill 18,176

OR Tuality Health Care Medicaid MCO Risk-based Capitation

1115 Washington 8,829

OR Washington County Health (Mental Health)

Mental Health PIHP


1115 Washington 38,853

OR Willamette Dental Dental PAHP Risk-based Capitation

1115 Benton, Clackamas, Clatsop, Columbia, Deschutes, Douglas, Jackson, Josephine, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Washington, Yamhill

63,843

PA Access Plus Program PCCM Fee-For-Service 1915(b) Bedford, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Columbia, Crawford, Elk, Erie, Forest, Franklin, Fulton, Huntingdon, Jefferson, Juniata, Lackawanna, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northumberland, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Wayne, Wyoming

290,807



State Plan Managed



Number of Enrollees

PA Aetna Better Health Commercial MCO Risk-based Capitation

1915(b) Adams, Berks, Bucks, Chester, Cumberland, Dauphin, Delaware, Lancaster, Lebanon, Lehigh, Montgomery, Northampton, Perry, Philadelphia, York

14,649

PA Albright LIFE Medical-only PIHP


1915(a) Clinton, Lancaster, Lycoming 76

PA AmeriChoice of Pennsylvania Commercial MCO Risk-based Capitation

1915(b) Bucks, Chester, Delaware, Montgomery, Philadelphia 67,946

PA AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan


1915(b) Adams, Berks, Cumberland, Dauphin, Lancaster, Lebanon, Lehigh, Northampton, Perry, York

94,083

PA AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan - VOL


1915(a) Carbon, Lackawanna, Luzerne, Monroe, Pike 2,698

PA APS Healthcare Disease Management

PAHP


1915(b) Bedford, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Columbia, Crawford, Elk, Erie, Forest, Franklin, Fulton, Huntington, Jefferson, Juniata, Lackwanna, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northumberland, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Wayne, Wyoming

53,048

PA Community Care Behavioral Health North Central


1915(b) Bradford, Cameron, Centre, Clarion, Clearfield, Columbia, Elk, Forest, Huntingdon, Jefferson, Juniat

133,254

PA Community Care Behavioral Health Northeast


1915(b) Lackawanna, Luzerne, Susquehanna, Wyoming 83,088

PA Community LIFE PACE Risk-based Capitation

PACE 14145, 15014, 15018, 15020, 15024, 15025, 15028, 15030, 15032, 15034, 15035, 15037, 15045, 15047, 15049, 15051, 15065, 15075, 15076, 15084, 15088, 15102, 15104, 15110, 15112, 15120, 15122, 15129, 15131, 15132, 15133, 15135, 15137, 15139, 15140, 15144, 15146, 15147, 15148, 15206, 15207, 15208, 15215, 15217, 15218, 15221, 15227, 15232, 15234, 15235, 15236, 15238, 15239

328

PA Counties of Armstrong/Indiana - Value Behavioral Health of PA


1915(b) Armstrong, Indiana 19,371

PA Counties of Bedford/Somerset - Community Behavioral Healthcare Network of Pennsylvania


1915(b) Bedford 14,807

PA Counties of Carbon/Monroe/Pike - Community Care Behavioral Health


1915(b) Carbon, Monroe, Pike 32,815



State Plan Managed



Number of Enrollees

PA Counties of Crawford/Mercer/Venango - MH/SUD PIHP Risk-based 1915(b) Crawford, Mercer, Venango Value Behavioral Health Capitation

PA Counties of Franklin/Fulton - Community MH/SUD PIHP Risk-based 1915(b) Franklin, Fulton Behavorial Healthcare Network of Capitation Pennsylvania

PA Counties of Lycoming/Clinton - MH/SUD PIHP Risk-based 1915(b) Clinton, Lycoming Community Behavioral Healthcare Capitation Network of Pennsylvania

PA County of Adams - Community Care MH/SUD PIHP Risk-based 1915(b) Adams Behavioral Health Capitation

PA County of Allegheny - Community Care MH/SUD PIHP Risk-based 1915(b), Allegheny Behavioral Health Capitation 1932(a)/1915(c)

PA County of Beaver - Value Behavioral MH/SUD PIHP Risk-based 1915(b) Beaver Health of PA Capitation

PA County of Berks - Community Care MH/SUD PIHP Risk-based 1915(b) Berks Behavioral Health Capitation

PA County of Blair County - Community MH/SUD PIHP Risk-based 1915(b) Blair Behavioral Healthcare Network of PA Capitation

PA County of Bucks - Magellan Behavioral MH/SUD PIHP Risk-based 1915(b) Bucks Health Capitation

PA County of Butler - Value Behavioral MH/SUD PIHP Risk-based 1915(b) Butler Health of PA Capitation

PA County of Cambria - Value Behavioral MH/SUD PIHP Risk-based 1915(b) Cambria Health Capitation

PA County of Chester - Community Care MH/SUD PIHP Risk-based 1915(b) Chester Behavioral Health Capitation

PA County of Cumberland - Community MH/SUD PIHP Risk-based 1915(b) Cumberland Behavioral Healthcare Network of PA, Inc. Capitation

PA County of Dauphin - Community MH/SUD PIHP Risk-based 1915(b) Dauphin Behavioral Healthcare Network of PA, Inc. Capitation

PA County of Delaware - Magellan MH/SUD PIHP Risk-based 1915(b) Delaware Behavioral Health Capitation

39,431

15,377

20,116

7,523

153,075

22,092

55,455

19,472

40,958

15,073

19,373

27,816

14,605

33,495

62,336

PA County of Erie - Value Behavioral Health MH/SUD PIHP Risk-based Capitation

1915(b) Erie 45,680



Page 56


State Plan Managed



Number of Enrollees

PA County of Fayette - Value Behavioral Health of PA


1915(b) Fayette 27,673

PA County of Lancaster - Community Behavioral Healthcare Network of PA, Inc.


1915(b) Lancaster 51,180

PA County of Lawrence - Value Behavioral Health of PA


1915(b) Lawrence 13,740

PA County of Lebanon - Community Behavioral Healthcare Network of PA, Inc.


1915(b) Lebanon 13,801

PA County of Lehigh - Magellan Behavioral Health


1915(b) Lehigh 46,752

PA County of Montgomery - Magellan Behavioral Health


1915(b) Montgomery 53,364

PA County of Northampton - Magellan Behavioral Health


1915(b) Northampton 28,478

PA County of Perry - Community Behavioral Healthcare Network of PA, Inc.


1915(b) Perry 3,888

PA County of Philadelphia - Community Behavioral Health


1915(b) Philadelphia 405,093

PA County of Washington - Value Behavioral Health of PA


1915(b) Washington 23,190

PA County of Westmoreland - Value Behavioral Health of PA


1915(b) Westmoreland 38,855

PA County of York - Community Care Behavioral Health


1915(b) York 40,931

PA Coventry Care Commercial MCO Risk-based Capitation


PA Everyday LIFE PACE Risk-based Capitation

PACE Lehigh, Northampton 16

PA Gateway Health Plan, Inc. Commercial MCO Risk-based Capitation

1915(b) Adams, Allegheny, Armstrong, Beaver, Berks, Butler, Cumberland, Dauphin, Fayette, Greene, Indiana, Lancaster, Lawrence, Lebanon, Lehigh, Northampton, Perry, Washington, Westmoreland, York

214,708



Page 57


State Plan Managed



Number of Enrollees

PA Gateway Health Plan, Inc. -VOL Commercial MCO Risk-based Capitation

1915(a) Blair, Erie 21,925

PA Health Partners of Philadelphia Commercial MCO Risk-based Capitation


PA Keystone Mercy Health Plan Commercial MCO Risk-based Capitation


PA LIFE at Home PACE Risk-based Capitation

PACE Chester, Delaware 90

PA LIFE Geisinger PACE Risk-based Capitation

PACE Lackawanna, Luzerne, Montour, Northumberland, Schuylkill, Snyder, Union, Wyoming

141

PA LIFE Lutheran Services PACE Risk-based Capitation

PACE Franklin 33

PA LIFE Northwestern PA Medical-only PIHP


1915(a) Erie 37

PA LIFE Pittsburgh PACE Risk-based Capitation

PACE 15006, 15007, 15015, 15017, 15031, 15044, 15046, 15056, 15064, 15071, 15082, 15086, 15090, 15091, 15101, 15106, 15108, 15116, 15126, 15127, 15136, 15142, 15143, 15201, 15202, 15203, 15204, 15205, 15209, 15210, 15211, 15212, 15213, 15214, 15216, 15219, 15220, 15222, 15223, 15224, 15225, 15226, 15228, 15229, 15233, 15237, 15241, 15243

364

PA LIFE St Mary PACE Risk-based Capitation

PACE Bucks 25

PA LIFE University of Pennsylvania PACE Risk-based Capitation

PACE 19103, 19104, 19121, 19130, 19131, 19139, 19142, 19143, 19151, 19153

368

PA Logisticare Solutions, LLC Transp PAHP Risk-based Capitation

1902(a)(70) Philadelphia 426,548

PA Mercy LIFE PACE Risk-based Capitation

PACE 19106, 19107, 19111, 19114, 19115, 19116, 19123, 19124, 19125, 19134, 19135, 19136, 19137, 19145, 19146, 19147, 19148, 19149, 19152, 19154

318

PA New Courtland LIFE PACE Risk-based Capitation

PACE Philadelphia County zip codes 19118, 19119, 19120, 19126, 19127, 19128, 19129, 19132, 19138, 19141,

180

PA Senior LIFE York Medical-only PIHP


1915(a) York 6



State Plan Managed



Number of Enrollees

PA Senior LIFE Johnstown PACE Risk-based Capitation

PACE Blair, Cambria, Dauphin, Somerset County zip codes 15531, 15928, 15935, 15953 and 15963, Westmoreland County zip codes 15944 and 15954, York

176

PA Senior LIFE Washingtown Medical-only PIHP


1915(a) Fayette, Greene and Washington 76

PA Unison Health Plan / MedPLUS Commercial MCO Risk-based Capitation


96,487

PA Unison Health Plan/MedPlus - VOL Commercial MCO Risk-based Capitation

1915(a) Blair, Bradford, Cambria, Carbon, Clarion, Columbia, Crawford, Erie, Forest, Franklin, Jefferson, Lackawanna, Luzerne, Mercer, Monroe, Montour, Pike, Schuylkill, Somerset, Sullivan, Susquehanna, Warren, Wyoming

33,734

PA UPMC Health Plan, Inc./UPMC for You Commercial MCO Risk-based Capitation


111,844

PA UPMC Health Plan, Inc./UPMC for You - VOL


1915(a) Bedford, Blair, Cambria, Clearfield, Crawford, Mercer, Somerset, Venango

6,379

PA Value Behavioral Health of PA (Greene County)


1915(b) Greene 6,756

PA Viecare Beaver PACE Risk-based Capitation

PACE Beaver 159

PA Viecare Butler Medical-only PIHP


1915(a) Butler 44



State Plan Managed



Number of Enrollees

PR American Health Medicare Commercial MCO Risk-based 1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, 17,256 Capitation Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas,

Bayamón, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marias, Las Piedras, Lioza, Luquillo, Manatí, Maricao, Maunabo, Mayagüez, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincon, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastian, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco

PR APS Healthcare MH/SUD PIHP Risk-based Capitation

1915(a) Aguas Buenas, Arecibo, Barceloneta, Caguas, Camuy, Canovanas, Carolina, Cayey, Ceiba, Ciales, Cidra, Culebra,

328,090

Fajardo, Florida, Gurabo, Hatillo, Humacao, Juncos, Lares, Las Piedras, Loiza, Luquillo, Manati, Morovis, Naguabo, Quebradillas, Rio Grande, San Lorenzo, Trujillo Alto, Utuado, Vega Baja, Vieques, Yabucoa

PR FHC Healthcare MH/SUD PIHP Risk-based 1915(a) Adjuntas, Aibonito, Arroyo, Barranquitas, Coamo, Guanica, 186,565 Capitation Guayama, Guayanilla, Jayuya, Juana Diaz, Maunabo,

Orocovis, Patillas, Penuelas, Ponce, Salinas, Santa Isabel, Villalba, Yauco

PR Humana Health Plans of Puerto Rico, Inc. Commercial MCO Risk-based 1915(a) Aguas Buenas, Aibonito, Arroyo, Barranquitas, Caguas, 213,624 Capitation Cayey, Cidra, Coamo, Guayama, Gurabo, Humacao, Juana

Diaz, Juncos, Las Piedras, Maunabo, Naguabo, Orocovis, Patillas, Salinas, San Lorenzo, Santa Isabel, Villalba, Yabucoa



State Plan Managed



Number of Enrollees

PR Humana Puerto Rico Commercial MCO Risk-based 1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, 10,202 Capitation Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas,

Bayamón, Cabo Rojo, Caguas, Camuy, Canóvanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerío, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marias, Las Piedras, Loíza, Luquillo, Manatí, Maricao, Maunabo, Mayaguëz, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincon, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastian, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco

PR MCS Advantage Commercial MCO Risk-based Capitation

1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas,

51,368

Bayamón, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Gurabo, Gyanabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marías, Las Piedras, Loiza, Luquillo, Manatí, Maricao, Maunabo, Mayagüez, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincón, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastián, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco

PR MCS Health Management Options, Inc. Commercial MCO Risk-based 1915(a) Aguada, Aguadilla, Añasco, Cabo Rojo, Canovanas, 265,946 Capitation Carolina, Ceiba, Culebra, Fajardo, Hormigueros, Isabela,

Lajas, Las Marias, Loiza, Luquillo, Maricao, Mayaguez, Moca, Rincon, Rio Grande, Sabana Grande, San German, San Juan, San Sebastian, Trujillo Alto, Vieques



State Plan Managed



Number of Enrollees

PR MMM Healthcare Inc. Commercial MCO Risk-based 1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, 48,529 Capitation Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas,

Bayamón, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marías, Las Piedras, Lioza, Luquillo, Manatí, Maricao, Maunabo, Mayaguëz, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincón, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastián, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco

PR PMC Medicare Choice Commercial MCO Risk-based Capitation

1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas,

29,223


PR Triple S Commercial MCO Risk-based 1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, 11,921 Capitation Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas,




State Plan Managed


Arrangement Operating Authority

1915(a)

1115

Geographic Area Served

Adjuntas, Arecibo, Barceloneta, Bayamón, Camuy, Cataño, Ciales, Comerío, Corozal, Dorado, Florida, Guanica, Guayanilla, Guaynabo, Hatillo, Jayuya, Lares, Manati, Morovis, Naranjito, Penuelas, Ponce, Quebradillas, Toa Alta, Toa Baja, Utuado, Vega Alta, Vega Baja, Yauco

Statewide

Number of Enrollees

329,117

14,698

1115

1115

Statewide

Statewide

2,404

78,331

PACE Statewide except for Zip Codes Block Island 02807 194



1932(a)

1932(a)

Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkely, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Edgefield, Fairfield, Florence, Greenville, Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Sumter, Union, Williamsburg, York

Abbeville, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Fairfield, Florence, Greenville, Hampton, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Sumter, Union, Williamsburg, York

91,163

27,230

PR Triple-S, Inc. Commercial MCO Risk-based Capitation

RI Blue Cross & Blue Shield of Rhode Island Commercial MCO Risk-based Capitation

RI Connect Care Choice PCCM Fee-For-Service

RI Neighborhood Health Plan of Rhode Island


RI PACE Organization of Rhode Island PACE Risk-based Capitation

RI United HealthCare Dental - RIte Smiles Dental PAHP Risk-based Capitation

RI United HealthCare of New England Commercial MCO Risk-based Capitation

SC Absolute Total Care Medicaid MCO Risk-based Capitation

SC BlueChoice Health Plan Medicaid MCO Risk-based Capitation



State Plan Managed



Number of Enrollees

SC First Choice by Select Health of South Carolina, Inc.


1932(a) Abbeville, Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Edgefield, Fairfield, Florence, Georgetown, Greenville, Greenwood, Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, McCormick, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Sumter, Union, Williamsburg, York

204,001

SC Logisticare Transp PAHP Risk-based Capitation

1902(a)(70) Region 3, Region 4, Region 5, Region 6 605,693

SC Medical Transportation Management (MTM)

Transp PAHP Risk-based Capitation

1902(a)(70) Region 1, Region 2 201,898

SC Palmetto SeniorCare (PACE) PACE Risk-based Capitation

PACE Lexington, Richland 387

SC South Carolina Solutions PCCM Fee-For-Service 1932(a) Statewide 111,486

SC The Oaks PACE PACE Risk-based Capitation

PACE Orangeburg County 70

SC Unison Health Plan of SC Medicaid MCO Risk-based Capitation

1932(a) Abbeville, Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Edgefield, Fairfield, Florence, Georgetown, Greenville, Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Sumter, Union, Williamsburg, York

70,295

SD PRIME PCCM Fee-For-Service 1932(a) Statewide 90,953

TN Alexian Brothers Community Services PACE Risk-based Capitation

PACE Hamilton 328

TN AmeriChoice - East TN Medicaid MCO Risk-based Capitation

1115 East Tennessee 181,429

TN AmeriChoice - Middle TN Medicaid MCO Risk-based Capitation

1115 Middle Tennessee 198,193

TN AmeriChoice - West TN Medicaid MCO Risk-based Capitation

1115 West Tennessee 165,791



State Plan Managed



Number of Enrollees

TN AmeriGroup Community Care Medicaid MCO Risk-based Capitation

1115 Middle Tennessee 195,582

TN DentaQuest *Dental Benefit Manager PAHP

Non-risk Capitation


TN SXC Health Solutions Corporation *Pharmacy Benefits

Manager PAHP

Non-risk Capitation

1115 Statewide 1,069,182

TN Volunteer State Health Plan (Bluecare) - East


1115 East Tennessee 233,782

TN Volunteer State Health Plan (Bluecare) - West


1115 West Tennessee 185,851

TN Volunteer State Health Plan (TennCare Select)

*Prepaid Inpatient Health

Plan (PIHP), partial risk,

partial capitation

Partial Capitation 1115 Statewide 43,611

TX Aetna Commercial MCO Risk-based Capitation

1915(b) Atascosa, Bexar, Comal, Denton, Guadalupe, Hood, Johnson, Kendall, Medina, Parker, Tarrant, Wilson, Wise

47,924

TX Amerigroup (STAR) Medicaid MCO Risk-based Capitation

1915(b) Bastrop, Brazoria, Burnet, Caldwell, Collin, Dallas, Denton, Ellis, Fort Bend, Galveston, Harris, Hays, Hood, Hunt, Johnson, Kaufman, Lee, Montgomery, Navarro, Parker, Rockwell, Tarrant, Travis, Waller, Williamson, Wise

407,236

TX Amerigroup (STAR+PLUS) Medicaid MCO Risk-based Capitation

1915(b), 1915(b)/(c)

Atascosa, Bastrop, Bexar, Blanco, Brazoria, Burnet, Caldwell, Comal, Fort Bend, Galveston, Guadalupe, Harris, Hays, Kendall, Lee, Medina, Montgomery, Travis, Waller, Williamson, Wilson

57,192

TX Bienvivir Senior Health Service PACE Risk-based Capitation

PACE 79901, 79902, 79903, 79904, 79905, 79907, 79915, 79924, 79925, 79930, 79935, 79936

808

TX Community First Commercial MCO Risk-based Capitation

1915(b) Atascosa, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson 83,486

TX Community Health Choice Medicaid MCO Risk-based Capitation

1915(b) Brazoria, Fort Bend, Galveston, Harris, Montgomery, Waller 123,955

TX Cook Children's Medicaid MCO Risk-based Capitation

1915(b) Denton, Hood, Johnson, Parker, Tarrant, Wise 59,216

TX Driscoll Medicaid MCO Risk-based Capitation

1915(b) Aransas, Bee, Calhoun, Jim Wells, Kleberg, Nueces, Refugio, San Patricio, Victoria

43,188



State Plan Managed



Number of Enrollees

TX El Paso First Premier Commercial MCO Risk-based Capitation

1915(b) El Paso 47,163

TX Evercare Medicaid MCO Risk-based Capitation

1915(b), 1915(b)/(c)

Bastrop, Blanco, Brazoria, Burnet, Caldwell, Crosby, Floyd, Fort Bend, Galveston, Garza, Hale, Harris, Hays, Hockley, Lamb, Lee, Lubbock, Lynn, Montgomery, Terry, Travis, Waller, Williamson

56,196

TX First Care Commercial MCO Risk-based Capitation

1915(b) Crosby, Floyd, Garza, Hale, Hockley, Lamb, Lubbock, Lynn, Terry

28,426

TX Jan Werner Adult Day Care Center PACE Risk-based Capitation

PACE 79015, 79101, 79102, 79103, 79104, 79106, 79107, 79108, 79109, 79110, 79111, 79118, 79119, 79121, 79124

136

TX La Paloma PACE Risk-based Capitation

PACE 79403, 79404, 79407, 79408, 79414, 79415, 79416, 79423, 79424, 79452, 79453, 79464, 79490, 79493, 79499

4

TX McKesson Health Solutions Disease Management

PAHP



TX Molina (STAR) Medicaid MCO Risk-based Capitation


TX Molina (STAR+Plus) Medicaid MCO Risk-based Capitation

1915(b), 1915(b)/(c)

Atascosa, Bexar, Brazoria, Comal, Fort Bend, Galveston, Guadalupe, Harris, Kendall, Medinal, Montgomery, Waller, Wilson

18,688

TX Parkland Community Health Plan Medicaid MCO Risk-based Capitation

1915(b) Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, Rockwall 152,852



State Plan Managed



Number of Enrollees

TX PCCM PCCM Fee-For-Service 1932(a) Anderson, Andrews, Angelina, Archer, Armstrong, Austin, Bailey, Bandera, Baylor, Bell, Bordon, Bosque, Bowie, Brazos, Brewster, Briscoe, Brooks, Brown, Burleson, Callahan, Cameron, Camp, Carson, Cass, Castro, Chambers, Cherokee, Childress, Clay, Cochran, Coke, Coleman, Collingsworth, Colorado, Comanche, Concho, Cooke, Coryell, Cottle, Crane, Crockett, Dallam, Dawson, Deaf Smith, Delta, DeWitt, Dickens, Dimmit, Donley, Duval, Eastland, Ector, Edwards, Erath, Falls, Fannin, Fayette, Fisher, Foard, Franklin, Freestone, Frio, Gaines, Gillespie, Glasscock, Goliad, Gonzales, Gray, Grayson, Gregg, Grimes, Hall, Hamilton, Hansford, Hardeman, Hardin, Harrison, Hartley, Haskell, Hemphill, Henderson, Hildalgo, Hill, Hopkins, Houston, Howard, Hutchinson, Irion, Jack, Jackson, Jasper, Jeff Davis, Jefferson, Jim Hogg, Jones, Karnes, Kenedy, Kent, Kerr, Kimble, King, Kinney, Knox, La Salle, Lamar, Lampasas, Lavaca, Leon, Liberty, Limestone, Lipscomb, Live Oak, Llano, Loving, Madison, Marion, Martin, Mason, Matagorda, Maverick, McCulloch, McLennan, McMullen, Menard, Midland, Milam, Mills, Mitchell, Montague, Moore, Morris, Motley, Nacogdoches, Newton, Nolan, Ochiltree, Oldham, Orange, Palo Pinto, Panola, Parmer, Pecos, Polk, Potter, Presidio, Rains, Randall, Reagan, Real, Red River, Reeves, Roberts, Robertson, Runnels, Sabine, San Augustine, San Jacinto, San Saba, Schleicher, Scurry, Shackelford, Shelby, Sherman, Smith, Somervell, Starr, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terrell, Throckmorton, Titus, Tom Green, Trinity, Tyler, Upshur, Upton, Uvalde, Val Verde, Van Zandt, Walker, Ward, Washington, Webb, Wharton, Wheeler, Wichita, Wilbarger, Willacy, Winkler, Wood, Yoakum, Young, Zapata, Zavala

848,808

TX Superior HealthPlan (STAR Health) Medicaid MCO Risk-based Capitation


TX Superior HealthPlan (STAR) Medicaid MCO Risk-based Capitation

1915(b) Atascosa, Bastrop, Bexar, Burnet, Caldwell, Comal, Crosby, El Paso, Floyd, Garza, Guadalupe, Hale, Hays, Hockley, Hudspeth, Kendall, Lamb, Lee, Lubbock, Lynn, Medina, Terry, Travis, Williamson, Wilson

237,342

TX Superior HealthPlan (STAR+Plus) Medicaid MCO Risk-based Capitation

1915(b), 1915(b)/(c)

Aransas, Atascosa, Bee, Bexar, Calhoun, Comal, Guadalupe, Jim Wells, Kendall, Kleberg, Medina, Nueces, Refugio, San Patricio, Victoria, Wilson

36,999

TX Texas Children's Health Plan Medicaid MCO Risk-based Capitation




State Plan Managed



Number of Enrollees

TX Unicare Commercial MCO Risk-based Capitation

1915(b) Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, Rockwall 20,932

TX United Commercial MCO Risk-based Capitation


TX ValueOptions MH/SUD PIHP FFS/Some Risk Based Capitation

1915(b) Collin County, Dallas County, Ellis County, Hunt County, Kaufman County, Navarro County, Rockwall County

365,127

UT Bear River Mental Health Mental Health PIHP


1915(b) Box Elder, Cache, Rich 13,107

UT Central Utah Counseling Center Mental Health PIHP


1915(b) Juab, Millard, Piute, Sanpete, Sevier, Wayne 7,705

UT Davis Behavioral Health Mental Health PIHP


1915(b) Davis 18,052

UT Four Corners Community Behavioral Health

Mental Health PIHP


1915(b) Carbon, Emery, Grand 4,608

UT Healthy Outcomes Medical Excellence (HOME)

*PIHP Covering both Medical and

Mental Health

Non-risk Capitation


UT Healthy U Medical-only PAHP

Non-risk Capitation

1115, 1915(b) Davis County, Salt Lake County, Utah County, Weber County 33,258

UT Molina Healthcare of Utah (Molina) Medicaid MCO Risk-based Capitation

1115, 1915(b) Davis, Salt Lake, Utah, Weber 46,148

UT Non-Emergency Medical Transportation Transp PAHP Risk-based Capitation


UT Northeastern Counseling Center Mental Health PIHP


1915(b) Daggett, Duchesne, Uintah 4,467

UT Select Access PCCM Fee-For-Service 1115, 1915(b) Davis County, Salt Lake County, Utah County, Weber County 65,431

UT Southwest Behavioral Health Services Mental Health PIHP


1915(b) Beaver, Garfield, Iron, Kane, Washington 20,317

UT Valley Mental Health Mental Health PIHP


1915(b) Salt Lake, Summit, Tooele 93,183

UT Wasatch Mental Health Mental Health PIHP


1915(b) Utah County 38,255



Page 68


State Plan Managed



Number of Enrollees

UT Weber Human Services Mental Health PIHP


1915(b) Morgan, Weber 21,715

VA AllCare for Seniors PACE Risk-based Capitation

PACE Buchanan, Dickerson, Russell, Tazewell 33

VA Amerigroup Community Care Medicaid MCO Risk-based Capitation

1915(b) Alexandria City, Arlington County, Fairfax City, Fairfax County, Falls Church City, Fauquier County, Loudoun County, Manassas City, Manassas Park City, Prince William County

35,322

VA Anthem Healthkeepers Plus Commercial MCO Risk-based Capitation

1915(b) Accomack County, Albemarle County, Alexandria City, Amelia County, Arlington County, Brunswick County, Buckingham County, Caroline County, Charles City County, Charlottesville City, Chesapeake City, Chesterfield County, Clarke County, Colonial Heights City, Cumberland County, Dinwiddie County, Emporia City, Essex County, Fairfax City, Fairfax County, Falls Church City, Fauquier County, Fluvanna County, Franklin City, Frederick County, Fredericksburg City, Gloucester County, Goochland County, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Henrico County, Hopewell City, Isle of Wight County, James City County, King and Queen County, King George County, King William County, Lancaster County, Loudoun County, Louisa County, Lunenburg County, Madison County, Manassas City, Manassas Park City, Mathews County, Mecklenburg County, Middlesex County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Northumberland County, Nottoway County, Orange County, Petersburg City, Poquoson City, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Prince William County, Richmond City, Richmond County, Southampton County, Spotsylvania County, Stafford County, Suffolk City, Surry County, Sussex County, Virginia Beach City, Warren County, Westmoreland County, Williamsburg City, Winchester City, York County

190,853

VA Centra Health PACE Risk-based Capitation

PACE Amherst, Bedford, Campbell, Forest, Lynchburg 59

VA LogistiCare Solutions Transp PAHP Risk-based Capitation

1902(a)(70) Statewide 523,654



State Plan Managed



Number of Enrollees

VA MEDALLION PCCM Fee-For-Service 1915(b) Alleghany County, Bath County, Bland County, Bristol City, 55,837 Buchanan County, Carroll County, Covington City, Craig County, Dickenson County, Galax, Grayson County, Highland County, Lee County, Norton, Russell, Scott County, Smyth County, Tazewell County, Washington County, Wise County

VA Mountain Empire PACE Risk-based PACE Lee, Norton, Scott, Wise 65 Capitation

VA Optima Family Care Commercial MCO Risk-based 1915(b) Accomack County, Albemarle County, Amelia County, 136,755 Capitation Amherst County, Appomattox County, Augusta County,

Brunswick County, Buckingham County, Campbell County, Caroline County, Charles City County, Charlotte County, Charlottesville City, Chesapeake City, Chesterfield County, Clarke County, Colonial Heights City, Cumberland County, Danville City, Dinwiddie County, Emporia City, Essex County, Fluvanna County, Franklin City, Frederick County, Gloucester County, Goochland County, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Harrisonburg City, Henrico County, Hopewell City, Isle of Wight County, James City County, King and Queen County, King William County, Lancaster County, Louisa County, Lunenburg County, Madison County, Mathews County, Mecklenburg County, Middlesex County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Northumberland County, Nottoway County, Orange County, Page County, Petersburg City, Pittsylvania County, Poquoson City, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Rappahannock County, Richmond City, Richmond County, Rockingham County, Shenandoah County, Southampton County, Staunton City, Suffolk City, Surry County, Sussex County, Virginia Beach City, Warren County, Waynesboro City, Westmoreland County, Williamsburg City, Winchester City, York County

VA Riverside Peninsula PACE Risk-based PACE Hampton, Newport News, Poquoson, Southeastern portion of 270 Capitation York County

VA Sentara Senior Community Care PACE Risk-based Capitation

PACE Chesapeake, Norfolk, Portsmouth, Virginia Beach 142



State Plan Managed



Number of Enrollees

VA Southern Health CareNet Commercial MCO Risk-based 1915(b) Albemarle County, Amelia County, Amherst County, 22,533 Capitation Appomattox County, Augusta County, Buckingham County,

Campbell County, Caroline County, Charles City County, Charlottesville, Chesterfield County, Colonial Heights City, Cumberland County, Dinwiddie County, Essex County, Fluvanna County, Goochland County, Greene County, Hanover County, Henrico County, Hopewell City, King and Queen County, King William County, Lancaster County, Louisa County, Lunenburg County, Lynchburg, Mathews County, Mecklenburg County, Middlesex County, Nelson County, New Kent County, Northumberland County, Nottoway County, Orange County, Petersburg City, Powhatan County, Prince George County, Richmond City, Richmond County, Staunton, Surry County, Sussex County, Waynesboro, Westmoreland County

VA Virginia Premier Health Plan Medicaid MCO Risk-based Capitation

1915(b) Accomack County, Albemarle County, Amelia County, Appomattox County, Augusta County, Bedford City, Bedford

138,191

County, Botetourt County, Brunswick County, Buckingham County, Buena Vista City, Campbell County, Caroline County, Charles City County, Charlotte County, Charlottesville City, Chesapeake City, Chesterfield County, Clarke County, Colonial Heights City, Culpeper County, Cumberland County, Danville, Dinwiddie County, Emporia City, Floyd County, Fluvanna County, Franklin City, Franklin County, Frederick County, Fredericksburg City, Giles County, Goochland County, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Harrisonburg City, Henrico County, Henry County, Hopewell City, King George County, King William County, Lexington City, Louisa County, Lunenburg County, Lynchburg City, Madison County, Martinsville City, Mecklenburg County, Montgomery County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Nottoway County, Orange County, Page County, Patrick County, Petersburg City, Pittsylvania County, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Pulaski County, Radford City, Rappahannock County, Richmond City, Roanoke City, Roanoke County, Rockbridge County, Rockingham County, Salem City, Shenandoah County, Southampton County, Spotsylvania County, Stafford County, Staunton City, Suffolk City, Surry County, Sussex County, Virginia Beach City, Warren County, Waynesboro City, Westmoreland County, Winchester City, Wythe County

VT Global Committment to Health Medicaid MCO Risk-based 1115 Statewide 100,251 Capitation



State Plan Managed



Number of Enrollees

VT Vermont PACE PACE Risk-based Capitation

PACE Chittenden County, Lower Grand Isle County, Rutland County 108

WA Asuris Northwest Health Commercial MCO Risk-based Capitation

1932(a) Spokane County 2,321

WA City of Seattle Human Services Disease Management

PAHP


1932(a) King 8,342

WA Columbia United Providers Commercial MCO Risk-based Capitation

1932(a) Clark 43,254

WA Community Health Plan Commercial MCO Risk-based Capitation

1932(a) Adams, Benton, Chelan, Clark, Cowlitz, Douglas, Ferry, Franklin, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oriellle, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Yakima

212,298

WA Group Health Cooperative Commercial MCO Risk-based Capitation

1932(a) King, Kitsap, Pierce, Snohomish, Spokane, Thurston 22,823

WA Kaiser Foundation Health Plan Commercial MCO Risk-based Capitation

1932(a) Clark, Cowlitz 715

WA Molina Healthcare Commercial MCO Risk-based Capitation

1932(a) Adams, Asotin, Benton, Chelan, Clallam, Clark, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, King, Kitsap, Kittitas, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Orielle, Pierce, San Juan, Skagit, Snohomish, Spokane, Stevens, Thurston, Walla Walla, Whatcom, Whitman, Yakima

329,866

WA Molina Healthcare (WMIP) Commercial MCO Risk-based Capitation

1932(a) Snohomish 3,924

WA OptumHealth MH/SUD PIHP Risk-based Capitation

1915(b) Pierce County 32,021

WA PCCM Tribal Clinics PCCM Fee-For-Service 1932(a) Statewide 6,381

WA Providence ElderPlace - Seattle PACE Risk-based Capitation

PACE King 364

WA Regence Blue Shield Commercial MCO Risk-based Capitation

1932(a) Clallam, Grays Harbor, Island, Pacific, Pierce, San Juan, Skagit, Snohomish, Yakima

38,958



State Plan Managed



Number of Enrollees

WA Regional Support Network Mental Health PIHP



WI Abri Health Plan -- Medicaid HMO Commercial MCO Risk-based Capitation

1932(a) Brown, Dodge, Green Lake, Jefferson, Kenosha, Kewaunee, Lincoln, Marathon, Marquette, Milwaukee, Oconto, Oneida, Outagamie, Ozaukee, Portage, Racine, Shawano, Vilas, Washington, Waukesha, Waupaca, Waushara, Winnebago

16,388

WI Abri Health Plan -- SSI Commercial MCO Risk-based Capitation

1932(a) Brown, Dodge, Jefferson, Kenosha, Kewaunee, Milwaukee, Outagamie, Ozaukee, Racine, Washington, Waukesha, Waupace, Winnebago

1,714

WI Care Wisconsin First, Inc. Long Term Care PIHP


1915(b)/(c) Columbia, Dodge, Green Lake, Jefferson, Marquette, Washington, Waukesha, Waushara

3,074

WI Care Wisconsin Health Plan, Inc. (Partnership)


1932(a)/1915(c) Dane County 1,165

WI Children's Community Health Plan - Medicaid HMO


1932(a) Kenosha, Milwaukee, Ozaukee, Racine, Walworth, Washington, Waukesha

24,425

WI CHP-LTS, Inc. Long Term Care PIHP


1915(b)/(c) Chippewa, Dunn, Eau Claire, Pierce, St. Croix 1,136

WI Community Care Health Plan, Inc. Commercial MCO Risk-based Capitation

1932(a)/1915(c) Milwaukee 362

WI Community Care of Central Wisconsin Long Term Care PIHP


1915(b)/(c) Marathon, Portage, Wood 2,694

WI Community Care Organization (PACE) PACE Risk-based Capitation

PACE Milwaukee 880

WI Community Care, Inc. Long Term Care PIHP


1915(b)/(c) Calumet, Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Walworth, Washington, Waukesha

6,385

WI Compcare -- Medicaid HMO Commercial MCO Risk-based Capitation

1932(a) Adams, Ashland, Barron, Bayfield, Buffalo, Burnett, Chippewa, Crawford, Douglas, Dunn, Eau Claire, Grant, Green, Jackson, Juneau, La Crosse, Marquette, Monroe, Pepin, Pierce, Polk, Richland, Rusk, Sauk, Sawyer, St. Croix, Trempealeau, Vernon, Washburn

31,106

WI Dane County Human Services Department -- CCF


1915(a) Dane 131

WI Dean Health Plan -- Medicaid HMO Commercial MCO Risk-based Capitation

1932(a) Columbia, Dane, Dodge, Grant, Green, Iowa, Jefferson, Kenosha, Milwaukee, Ozaukee, Racine, Rock, Sauk, Walworth, Waukesha

51,206



State Plan Managed



Number of Enrollees

WI Group Health Cooperative Of Eau Claire -- Medicaid HMO


1932(a) Ashland, Barron, Bayfield, Buffalo, Burnett, Chippewa, Clark, Columbia, Crawford, Douglas, Dunn, Eau Claire, Grant, Green, Iowa, Jackson, Juneau, Lafayette, Lincoln, Marathon, Pepin, Pierce, Polk, Price, Rusk, Sauk, Sawyer, St. Croix, Taylor, Trempealeau, Washburn

42,529

WI Group Health Cooperative of Eau Claire County SSI


1932(a) Buffalo, Jackson, La Crosse, Monroe, Trempealeau, Vernon 1,876

WI Group Health Cooperative Of South Central WI -- Medicaid HMO


1932(a) Dane, Monroe, Vernon 4,306

WI Gundersen Lutheran Health Plan Medicaid HMO


1932(a) Buffalo, Crawford, Grant, Jackson, Juneau, La Crosse, Monroe, Trempealeau, Vernon

17,281

WI Health Tradition Health Plan -- Medicaid HMO


1932(a) Buffalo, Crawford, Grant, La Crosse, Monroe, Trempealeau, Vernon

9,499

WI Independent Care (iCare) - Medicaid HMO Medicaid MCO Risk-based Capitation

1932(a) Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Washington, Waukesha

4,409

WI Independent Care Health Plan -- SSI Medicaid MCO Risk-based Capitation

1932(a) Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Washington, Waukesha

8,907

WI Independent Care Health Plan (SNP) Medicaid MCO Risk-based Capitation

1932(a)/1915(c) Milwaukee 61

WI Lakeland Care District Long Term Care PIHP


1915(b)/(c) Fond du Lac 2,511

WI Managed Health Services -- Medicaid HMO


1932(a) Brown, Calumet, Clark, Dodge, Fond du lac, Green Lake, Jefferson, Kenosha, Langlade, Manitowoc, Marathon, Marquette, Menominee, Milwaukee, Oconto, Oneida, Outagamie, Ozaukee, Portage, Racine, Rock, Shawano, Sheboygan, Taylor, Vilas, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood

75,262

WI Managed Health Services -- SSI Medicaid MCO Risk-based Capitation

1932(a) Kensosha, Milwaukee, Racine, Waukesha 5,376

WI MercyCare Insurance Company -- Medicaid HMO


1932(a) Dane, Green, Jefferson, Rock, Walworth 15,946

WI Milwaukee County Department of Family Care

Long Term Care PIHP


1915(b)/(c) Milwaukee 7,484

WI Milwaukee County Human Services Department -- Wraparound Milwaukee


1915(a) Milwaukee 869



State Plan Managed



Number of Enrollees

WI Network Health Plan -- Medicaid HMO Commercial MCO Risk-based Capitation

1932(a) Brown, Calumet, Clark, Dodge, Fond du lac, Forest, Green Lake, Jefferson, Kenosha, Langlade, Lincoln, Manitowoc, Marathon, Marquette, Menominee, Milwaukee, Oconto, Oneida, Outagamie, Ozaukee, Portage, Racine, Rock, Shawano, Sheboygan, Taylor, Vilas, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood

49,677

WI Network Health Plan - SSI Commercial MCO Risk-based Capitation

1932(a) Kenosha, Milwaukee, Racine, Waukesha 2,670

WI Northern Bridges Long Term Care PIHP


1915(b)/(c) Ashland, Barron, Bayfield, Burnett, Douglas, Iron, Polk, Price, Rusk, Sawyer, Washburn

1,880

WI Partnership Health Plan, Inc. Commercial MCO Risk-based Capitation

1932(a)/1915(c) Chippewa, Dunn, Eau Claire 1,885

WI Physicians Plus Health Plan - Medicaid HMO


1932(a) Dane 7,776

WI Security Health Plan -- Medicaid HMO Commercial MCO Risk-based Capitation

1932(a) Adams, Ashland, Barron, Chippewa, Clark, Eau Claire, Forest, Iron, Jackson, Juneau, Langlade, Lincoln, Marathon, Oneida, Polk, Portage, Price, Rusk, Sawyer, Shawano, Taylor, Vilas, Washburn, Waupaca, Wood

54,766

WI Southwest Family Care Alliance Long Term Care PIHP


1915(b)/(c) Crawford, Green, Juneau, Lafayette, Richland, Sauk 1,732

WI UnitedHealthcare of WI -- Medicaid HMO Commercial MCO Risk-based Capitation

1932(a) Ashland, Bayfield, Brown, Burnett, Calumet, Dodge, Douglas, Fond du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Manitowoc, Marathon, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Polk, Portage, Racine, Rock, Sawyer, Shawano, Sheboygan, St. Croix, Taylor, Walworth, Washburn, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood

230,591

WI UnitedHealthcare of WI -- SSI Commercial MCO Risk-based Capitation

1932(a) Ashland, Bayfield, Brown, Burnett, Calumet, Dodge, Douglas, Fond du lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Manitowoc, Marathon, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Polk, Portage, Racine, Rock, Shawano, Sheboygan, Taylor, Walworth, Washburn, Washington, Waukesha, Waupace, Waushara, Winnebago, Wood

9,870

WI Unity Health Insurance -- Medicaid HMO Commercial MCO Risk-based Capitation

1932(a) Columbia, Dane, Dodge, Green, Jefferson, Sauk 12,837

WI Western Wisconsin Cares Long Term Care PIHP


1915(b)/(c) Buffalo, Clark, Jackson, La Crosse, Monroe, Pepin, Trempealeau, Vernon

3,293



State Plan Managed



Number of Enrollees

WV Carelink Health Plan Commercial MCO Risk-based Capitation

1915(b), 1937 Barbour, Boone, Braxton, Brooke, Cabell, Calhoun, Clay, Doddridge, Fayette, Gilmer, Hancock, Harrison, Jackson, Kanawha, Lewis, Lincoln, Logan, Marion, Marshall, Mason, McDowell, Mercer, Mingo, Monongalia, Monroe, Nicholas, Ohio, Pleasants, Preston, Putnam, Raleigh, Randolph, Ritchie, Roane, Summers, Taylor, Tyler, Wayne, Webster, Wetzel, Wirt, Wood, Wyoming

53,667

WV Health Plan of the Upper Ohio Valley Commercial MCO Risk-based Capitation

1915(b), 1937 Barbour, Brooke, calhoun, Doddridge, Gilmer, Hancock, Harrison, Lewis, Marion, Marshall, Monongalia, Ohio, Pleasants, Preston, Randolph, Ritchie, Taylor, Tucker, Tyler, Upshur, webster, Wetzel, Wirt, Wood

28,234

WV Physician Assured Access System PCCM Fee-For-Service 1915(b) Statewide 9,345

WV Unicare Health Plan of WV Commercial MCO Risk-based Capitation

1915(b), 1937 Barbour, Berkeley, Boone, Braxton, brooke, Calhoun, Clay, Doddridge, Fayette, Gilmer, Greenbrier, Hampshire, Hancock, Hardy, Harrison, Jackson, Jefferson, Kanawha, Lewis, Lincoln, Logan, Marion, Marshall, McDowell, Mercer, Mineral, Mingo, Monongalia, Monroe, Morgan, Nicholas, Ohio, Pendleton, Pleasants, Pocahontas, Preston, Putnam, Raleigh, Randolph, Ritchie, Roane, Summers, Taylor, Tucker, Tyler, Upshur, Webster, Wetzel, Wirt, Wood, Wyoming

81,230

TOTAL NUMBER OF ENROLLEES: 56,267,341


Medicaid Managed Care Program Summary · Colorado Health Partnerships : Mental Health PIHP :...

Documents

Transcript of Medicaid Managed Care Program Summary · Colorado Health Partnerships : Mental Health PIHP :...